Healthcare Provider Details

I. General information

NPI: 1356646582
Provider Name (Legal Business Name): ROSELY CAJUSTE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 LOUIS AVE
ELMONT NY
11003-1236
US

IV. Provider business mailing address

89 LOUIS AVE
ELMONT NY
11003-1236
US

V. Phone/Fax

Practice location:
  • Phone: 347-454-3169
  • Fax:
Mailing address:
  • Phone: 347-454-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number301542-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: