Healthcare Provider Details

I. General information

NPI: 1104735877
Provider Name (Legal Business Name): MADISON ROSE DELTORO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

35 ROOSEVELT DR
BETHPAGE NY
11714-5537
US

IV. Provider business mailing address

35 ROOSEVELT DR
BETHPAGE NY
11714-5537
US

V. Phone/Fax

Practice location:
  • Phone: 516-640-1793
  • Fax:
Mailing address:
  • Phone: 516-640-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: