Healthcare Provider Details

I. General information

NPI: 1437247814
Provider Name (Legal Business Name): ROSANNE M CEBELENSKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 DEER PARK AVE
DEER PARK NY
11729-5211
US

IV. Provider business mailing address

1644 DEER PARK AVE
DEER PARK NY
11729-5211
US

V. Phone/Fax

Practice location:
  • Phone: 631-253-7005
  • Fax: 631-667-9411
Mailing address:
  • Phone: 631-253-7005
  • Fax: 631-667-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number202315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: