Healthcare Provider Details

I. General information

NPI: 1912465691
Provider Name (Legal Business Name): ROSEMARY OBAZE-ANYENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 JAMAICA AVE
QUEENS VILLAGE NY
11428-1548
US

IV. Provider business mailing address

14202 20TH AVE FL 3
FLUSHING NY
11351-3000
US

V. Phone/Fax

Practice location:
  • Phone: 718-297-1718
  • Fax:
Mailing address:
  • Phone: 347-542-5658
  • Fax: 718-445-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: