Provider Demographics
NPI:1184623134
Name:EMERT, ROGER IRA (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:IRA
Last Name:EMERT
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 1:555 MADISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3418
Mailing Address - Country:US
Mailing Address - Phone:646-754-2000
Mailing Address - Fax:646-754-9690
Practice Address - Street 1:555 MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3418
Practice Address - Country:US
Practice Address - Phone:646-754-2000
Practice Address - Fax:646-754-9690
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197044207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01629345Medicaid
NY04M161OtherEMPIRE BC/BS
NY01629345Medicaid
NYF97041Medicare UPIN