Provider Demographics
NPI:1770144040
Name:ROSSTIN, KEVIN (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:ROSSTIN
Suffix:
Gender:
Credentials:MD, FACS
Other - Prefix:DR
Other - First Name:KAYVAN
Other - Middle Name:
Other - Last Name:ANSARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1160 PINES LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6112
Mailing Address - Country:US
Mailing Address - Phone:212-466-6040
Mailing Address - Fax:
Practice Address - Street 1:113 E 39TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0968
Practice Address - Country:US
Practice Address - Phone:212-466-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3070342086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery