Provider Demographics
NPI:1730635749
Name:ROSH OB-GYN ULTRASOUND OF NJ LLC
Entity Type:Organization
Organization Name:ROSH OB-GYN ULTRASOUND OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSKILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-253-8111
Mailing Address - Street 1:PO BOX 231023
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-0023
Mailing Address - Country:US
Mailing Address - Phone:718-253-8111
Mailing Address - Fax:718-253-2333
Practice Address - Street 1:1973 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3435
Practice Address - Country:US
Practice Address - Phone:973-996-2284
Practice Address - Fax:212-725-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty