Provider Demographics
NPI:1851774574
Name:ROSH OB-GYN ULTRASOUND OF CA P.C.
Entity Type:Organization
Organization Name:ROSH OB-GYN ULTRASOUND OF CA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-439-4408
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:212-725-0123
Mailing Address - Fax:212-725-3738
Practice Address - Street 1:415 OLD NEWPORT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4248
Practice Address - Country:US
Practice Address - Phone:949-642-3606
Practice Address - Fax:949-548-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55324207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty