Healthcare Provider Details

I. General information

NPI: 1063345890
Provider Name (Legal Business Name): VERONICA ROSE URBOM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MISTY RD
ROCKY POINT NY
11778-9753
US

IV. Provider business mailing address

61 MISTY RD
ROCKY POINT NY
11778-9753
US

V. Phone/Fax

Practice location:
  • Phone: 516-503-6372
  • Fax:
Mailing address:
  • Phone: 516-503-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: