Individual
MEHDI ROUSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
355 BARD AVE, SURGERY, STATEN ISLAND, NY 10310
(718) 816-6440
(718) 816-3611
Mailing address
450 WEST 33RD STREET, PBS 12TH FLOOR, NEW YORK, NY 10001
(212) 356-4474
(212) 356-4608
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125645
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00249261
—
NC
Enumeration date
10/05/2006
Last updated
07/08/2007
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