Healthcare Provider Details

I. General information

NPI: 1124381173
Provider Name (Legal Business Name): ROSAURA VANRIEL M.S IN SPECIAL EDUC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 HENRY HUDSON PARKWAY
BRONX NY
10463
US

IV. Provider business mailing address

1326 EAST 69 STREET
BROOKLYN NY
11234
US

V. Phone/Fax

Practice location:
  • Phone: 134-752-3341
  • Fax:
Mailing address:
  • Phone: 347-884-3544
  • Fax: 347-523-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number745222971
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number745222971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: