MEDICARE: MR. NICOLA (NICK) ROSELLI OTR.CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	005312-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113231115	OTHER	NY	UNITEDHEALTHCARE
2	5054447	OTHER	NY	CIGNA
3	P439298	OTHER	NY	OXFORD
4	817707	OTHER	NY	MPN

General Provider Information

NPI Number	:	1427085885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICOLA (NICK) ROSELLI OTR.CHT

Provider Business Mailing Address
First Line	:	5847 FRANCIS LEWIS BLVD STE 200
Second Line	:
City	:	OAKLAND GDNS
State	:	NY
Zip	:	11364-1601
Country	:	US
Telephone Number	:	718-454-0842
Fax Number	:	718-454-1704

Provider Business Practice Location Address
First Line	:	5847 FRANCIS LEWIS BLVD STE 200
Second Line	:
City	:	OAKLAND GDNS
State	:	NY
Zip	:	11364-1601
Country	:	US
Telephone Number	:	718-454-0842
Fax Number	:	718-454-1704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	06/11/2024

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