Provider Demographics
NPI:1447471560
Name:CAMERON K. ROKHSAR, M.D. PC
Entity type:Organization
Organization Name:CAMERON K. ROKHSAR, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISCUOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-512-7616
Mailing Address - Street 1:901 STEWART AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4893
Mailing Address - Country:US
Mailing Address - Phone:516-512-7616
Mailing Address - Fax:516-512-7617
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-512-7616
Practice Address - Fax:516-512-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214852207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWQ871Medicare PIN
NYH71613Medicare UPIN