Healthcare Provider Details

I. General information

NPI: 1386714582
Provider Name (Legal Business Name): JOANNE M ROONEY RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PS 105 725 BRADY AVENUE
BRONX NY
10462
US

IV. Provider business mailing address

34 SCHOFIELD ST
BRONX NY
10464-1530
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-4060
  • Fax:
Mailing address:
  • Phone: 718-696-4060
  • Fax: 718-828-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF331218
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: