Provider Demographics
NPI:1255776019
Name:ROZAK, PHILLIP RYAN (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:RYAN
Last Name:ROZAK
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 1:1676 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5416
Mailing Address - Country:US
Mailing Address - Phone:315-624-8110
Mailing Address - Fax:315-624-5775
Practice Address - Street 1:1676 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5416
Practice Address - Country:US
Practice Address - Phone:315-624-8110
Practice Address - Fax:315-624-5775
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100470632086S0122X
NY3331862086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery