Provider Demographics
NPI:1265686026
Name:AMY C ROSKIN MD PA
Entity type:Organization
Organization Name:AMY C ROSKIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:ROSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-718-7180
Mailing Address - Street 1:8333 W MCNAB RD
Mailing Address - Street 2:STE 122
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3203
Mailing Address - Country:US
Mailing Address - Phone:954-718-7180
Mailing Address - Fax:954-780-8025
Practice Address - Street 1:8333 W MCNAB RD
Practice Address - Street 2:STE 122
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3203
Practice Address - Country:US
Practice Address - Phone:954-718-7180
Practice Address - Fax:954-780-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68024207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288Medicare PIN