Healthcare Provider Details

I. General information

NPI: 1740146240
Provider Name (Legal Business Name): DENNISY DE LA ROSA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E FORDHAM RD
BRONX NY
10458-5049
US

IV. Provider business mailing address

625 E FORDHAM RD
BRONX NY
10458-5049
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-1900
  • Fax: 718-563-4039
Mailing address:
  • Phone: 718-933-1900
  • Fax: 718-563-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: