Healthcare Provider Details

I. General information

NPI: 1477473346
Provider Name (Legal Business Name): JUSTIN ROSIE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 GENESEE ST STE 201
AUBURN NY
13021-3529
US

IV. Provider business mailing address

115 S HERMAN AVE
AUBURN NY
13021-4264
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-8477
  • Fax:
Mailing address:
  • Phone: 716-201-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408709-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: