Healthcare Provider Details

I. General information

NPI: 1861767667
Provider Name (Legal Business Name): ROSALIA M DEANGELIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 ANDREWS AVE
BRONX NY
10453-1303
US

IV. Provider business mailing address

2195 ANDREWS AVE
BRONX NY
10453-1303
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-3258
  • Fax: 718-563-1411
Mailing address:
  • Phone: 718-584-3258
  • Fax: 718-563-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number230850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: