Provider Demographics
NPI:1184617797
Name:ROSSMAN, JEFF (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:ROSSMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SAW MILL RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2311
Mailing Address - Country:US
Mailing Address - Phone:631-692-4262
Mailing Address - Fax:
Practice Address - Street 1:49 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-2311
Practice Address - Country:US
Practice Address - Phone:631-692-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0367531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T81207Medicare UPIN
D8G781Medicare ID - Type Unspecified