Provider Demographics
NPI:1659357754
Name:ROSCA, MIHAI (MD)
Entity Type:Individual
Prefix:MR
First Name:MIHAI
Middle Name:
Last Name:ROSCA
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 1:1050 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1503
Mailing Address - Country:US
Mailing Address - Phone:516-484-3430
Mailing Address - Fax:516-484-3482
Practice Address - Street 1:1050 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1503
Practice Address - Country:US
Practice Address - Phone:516-484-3430
Practice Address - Fax:516-484-3482
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2133562086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02375533Medicaid
NY02375533Medicaid