| Doctor Name: | THERESA ROSKO |
| NPI Number: | 1043243066 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPA-C |
| License Number: | 003515 |
| Business Practice Address: | 101 Hospital Rd Patchogue, NY - 117724870 |
| Business Phone Number: | 6316547100 |
| Business Fax Number: | |
| Mailing Address: | 148 Big Fresh Pond Rd, SOUTHAMPTON |
| State: | NY |
| Postal Code: | 119682213 |
| Phone Number: | 6312834451 |
| Fax Number: | |
| NPI Enumeration Date: | 07/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 003515 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |