Healthcare Provider Details

I. General information

NPI: 1730405861
Provider Name (Legal Business Name): ANNA ELLA ROTTERSMAN SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150-11 HILLSIDE AVENUE
JAMAICA NY
11432
US

IV. Provider business mailing address

150-11 HILLSIDE AVENUE
JAMAICA NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 178-739-5778
  • Fax: 178-523-2728
Mailing address:
  • Phone: 718-739-5778
  • Fax: 718-523-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPO37990-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: