Provider Demographics
NPI:1649221425
Name:ROEN, JANET LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:LESLIE
Last Name:ROEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3422
Mailing Address - Country:US
Mailing Address - Phone:212-679-8885
Mailing Address - Fax:212-683-3919
Practice Address - Street 1:220 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3422
Practice Address - Country:US
Practice Address - Phone:212-679-8885
Practice Address - Fax:212-683-3915
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134794208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00690729Medicaid
B17501Medicare UPIN
65A661Medicare ID - Type Unspecified