Provider Demographics
NPI:1922433853
Name:ROCHELIN MEDICAL PC
Entity Type:Organization
Organization Name:ROCHELIN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FLEURGIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHELIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-896-9170
Mailing Address - Street 1:13571 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1630
Mailing Address - Country:US
Mailing Address - Phone:305-974-5548
Mailing Address - Fax:866-370-1485
Practice Address - Street 1:13571 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33181-1630
Practice Address - Country:US
Practice Address - Phone:305-974-5548
Practice Address - Fax:866-370-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03441196Medicaid