Provider Demographics
NPI:1295796464
Name:ROZO, ALBERTO (DO)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:ROZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7935
Mailing Address - Country:US
Mailing Address - Phone:718-457-7000
Mailing Address - Fax:718-899-4955
Practice Address - Street 1:9033 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7935
Practice Address - Country:US
Practice Address - Phone:718-457-7000
Practice Address - Fax:718-899-4955
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187566207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01580836Medicaid
NY187566OtherLICENSE NUMBER
NY01580836Medicaid