Healthcare Provider Details

I. General information

NPI: 1245566033
Provider Name (Legal Business Name): MRS. ROSEMARIE ROSSANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 DURHAM RD
EAST MEADOW NY
11554-4603
US

IV. Provider business mailing address

880 DURHAM RD
EAST MEADOW NY
11554-4603
US

V. Phone/Fax

Practice location:
  • Phone: 516-485-6021
  • Fax:
Mailing address:
  • Phone: 516-485-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number238408
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number689488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: