Healthcare Provider Details

I. General information

NPI: 1750501425
Provider Name (Legal Business Name): GEORGIA ROSE, CNM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W END AVE Y2
NEW YORK NY
10023-2504
US

IV. Provider business mailing address

123 W 93RD ST #10C
NEW YORK NY
10025-7572
US

V. Phone/Fax

Practice location:
  • Phone: 212-531-2229
  • Fax: 914-462-4409
Mailing address:
  • Phone: 212-864-3630
  • Fax: 212-864-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000247
License Number StateNY

VIII. Authorized Official

Name: GEORGIA ROSE
Title or Position: PRESIDENT
Credential: CNM
Phone: 718-543-9000