Healthcare Provider Details

I. General information

NPI: 1710065123
Provider Name (Legal Business Name): ROSEANN UNGARO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N STATION PLZ STE 301
GREAT NECK NY
11021-5007
US

IV. Provider business mailing address

45 N STATION PLZ STE 301
GREAT NECK NY
11021-5007
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-1033
  • Fax: 516-676-0521
Mailing address:
  • Phone: 516-521-4217
  • Fax: 516-629-6882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: