Healthcare Provider Details

I. General information

NPI: 1578622650
Provider Name (Legal Business Name): ELAINE I ROSENWACH F.N.P., C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVERSIDE DR SUITE 109
BINGHAMTON NY
13905-4176
US

IV. Provider business mailing address

161 RIVERSIDE DR SUITE 109
BINGHAMTON NY
13905-4176
US

V. Phone/Fax

Practice location:
  • Phone: 607-770-7074
  • Fax: 607-770-3452
Mailing address:
  • Phone: 607-770-7074
  • Fax: 607-770-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000681
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number330393
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: