Healthcare Provider Details

I. General information

NPI: 1649804238
Provider Name (Legal Business Name): ROSALINDA KAMOR SERVICE COORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 11/27/2023
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 MONTAUK HWY UNIT 2
OAKDALE NY
11769-1492
US

IV. Provider business mailing address

1227 MONTAUK HWY UNIT 2
OAKDALE NY
11769-1492
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax:
Mailing address:
  • Phone: 631-218-1545
  • Fax: 631-218-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: