Healthcare Provider Details

I. General information

NPI: 1427178318
Provider Name (Legal Business Name): ROSEMARIE HAASE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E SHORE RD SUITE 203
GREAT NECK NY
11023-2410
US

IV. Provider business mailing address

175 ROXBURY RD
GARDEN CITY NY
11530-1215
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-8657
  • Fax: 516-829-0002
Mailing address:
  • Phone: 516-877-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: