Healthcare Provider Details

I. General information

NPI: 1811311038
Provider Name (Legal Business Name): MARIA ROSSIELLO DPM,PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 N HANGAR RD SUITE 247-249
JAMAICA NY
11430-1826
US

IV. Provider business mailing address

75 N HANGAR RD SUITE 247-249
JAMAICA NY
11430-1826
US

V. Phone/Fax

Practice location:
  • Phone: 718-656-9500
  • Fax: 718-656-9503
Mailing address:
  • Phone: 718-656-9500
  • Fax: 718-656-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberN003212
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005252
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: