Healthcare Provider Details

I. General information

NPI: 1477555902
Provider Name (Legal Business Name): ROSEANNE NEGLIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 EASTCHESTER RD
BRONX NY
10461-2604
US

IV. Provider business mailing address

1621 EASTCHESTER RD
BRONX NY
10461-2604
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8040
  • Fax: 718-405-8048
Mailing address:
  • Phone: 718-405-8040
  • Fax: 718-405-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: