Healthcare Provider Details

I. General information

NPI: 1639188204
Provider Name (Legal Business Name): SYLVIA MARIE ROCHESTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

IV. Provider business mailing address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax: 718-741-4703
Mailing address:
  • Phone: 718-584-9000
  • Fax: 718-741-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number205301-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: