Healthcare Provider Details

I. General information

NPI: 1407951908
Provider Name (Legal Business Name): ROSITA RAZO ULEP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

IV. Provider business mailing address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 516-931-6835
Mailing address:
  • Phone: 718-945-7150
  • Fax: 516-931-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number165046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: