Provider Demographics
NPI:1952746752
Name:ROZHANSKY, IGOR
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:ROZHANSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3026
Mailing Address - Country:US
Mailing Address - Phone:212-501-7070
Mailing Address - Fax:212-712-9422
Practice Address - Street 1:288 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2302
Practice Address - Country:US
Practice Address - Phone:212-501-7070
Practice Address - Fax:212-712-9422
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008790-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician