Provider Demographics
NPI:1912393869
Name:ROSICKI, CHRISTOPHER JOEL
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOEL
Last Name:ROSICKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BEAVERDALE LN
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2507
Mailing Address - Country:US
Mailing Address - Phone:631-487-8246
Mailing Address - Fax:
Practice Address - Street 1:12 BEAVERDALE LN
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2507
Practice Address - Country:US
Practice Address - Phone:631-487-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278330207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology