Healthcare Provider Details

I. General information

NPI: 1578477758
Provider Name (Legal Business Name): ROSE CERNIGLIA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

11011 QUEENS BLVD APT 3N
FOREST HILLS NY
11375-5402
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433703
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: