Provider Demographics
NPI:1952388951
Name:ROSSI, DENNIS R (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:ROSSI
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 1:124 SUTTON PL S
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1728
Mailing Address - Country:US
Mailing Address - Phone:516-371-4219
Mailing Address - Fax:
Practice Address - Street 1:124 SUTTON PL S
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1728
Practice Address - Country:US
Practice Address - Phone:516-371-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1037472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00180089Medicaid
PA1025728690001Medicaid
MD5701058Medicaid
NYA400044518Medicare PIN
NY05517GMedicare PIN
MD215275YELVMedicare PIN
NY8998413091Medicare PIN
PA215003YEEMMedicare PIN
PA1025728690001Medicaid
NY8998498391Medicare PIN
NYB87379Medicare UPIN
NY00180089Medicaid
NY07075GMedicare PIN
NY06544GMedicare PIN