Provider Demographics
NPI:1649587254
Name:ROUX-LOUGH, PHILIP O (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:O
Last Name:ROUX-LOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W 56TH ST
Mailing Address - Street 2:#18F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4307
Mailing Address - Country:US
Mailing Address - Phone:646-715-7241
Mailing Address - Fax:
Practice Address - Street 1:235 W 56TH ST
Practice Address - Street 2:#18F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4307
Practice Address - Country:US
Practice Address - Phone:646-715-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150738208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice