Provider Demographics
NPI:1932729720
Name:ROA LOOR, JORGE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ANTONIO
Last Name:ROA LOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:
Other - Last Name:ROA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:MOUNT SINAI HOSPITAL DEPARTMENT OF NEUROSURGERY
Mailing Address - Street 2:PO BOX 1136
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:509-301-0424
Mailing Address - Fax:
Practice Address - Street 1:1468 MADISON AVE FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6508
Practice Address - Country:US
Practice Address - Phone:212-241-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program