Healthcare Provider Details

I. General information

NPI: 1720536287
Provider Name (Legal Business Name): ROSE SONA BRIGHT JIBU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WINDSOR ST HICKSVILLE
HICKSVILLE NY
11801-2357
US

IV. Provider business mailing address

1650 GRAND CONCOURSE BRONX LEBANON HOSPITAL CENTER
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 516-216-5189
  • Fax:
Mailing address:
  • Phone: 718-239-8389
  • Fax: 718-239-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: