Healthcare Provider Details

I. General information

NPI: 1619332319
Provider Name (Legal Business Name): CAROL ROSKIN-PAUL RN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E 86TH ST
NEW YORK NY
10028-0501
US

IV. Provider business mailing address

11 E 86TH ST
NEW YORK NY
10028-0501
US

V. Phone/Fax

Practice location:
  • Phone: 917-538-4003
  • Fax:
Mailing address:
  • Phone: 917-538-4003
  • Fax: 212-427-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number189949-1
License Number StateNY

VIII. Authorized Official

Name: MS. CAROL SUE ROSKIN-PAUL
Title or Position: NURSE
Credential: RN
Phone: 917-538-4003