Healthcare Provider Details

I. General information

NPI: 1376721993
Provider Name (Legal Business Name): ASHLEY MARIE ROVITO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 BELMONT ST
MASSENA NY
13662-1325
US

IV. Provider business mailing address

46 BELMONT ST.
MASSENA NY
13662
US

V. Phone/Fax

Practice location:
  • Phone: 315-705-4809
  • Fax:
Mailing address:
  • Phone: 315-705-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number286985-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: