Provider Demographics
NPI:1205289154
Name:ROSTOMIAN, ALLA
Entity type:Individual
Prefix:MS
First Name:ALLA
Middle Name:
Last Name:ROSTOMIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245146
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-5146
Mailing Address - Country:US
Mailing Address - Phone:718-661-3366
Mailing Address - Fax:718-661-4666
Practice Address - Street 1:14256 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6042
Practice Address - Country:US
Practice Address - Phone:718-661-3366
Practice Address - Fax:718-661-4666
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113272582OtherTAX ID