Healthcare Provider Details

I. General information

NPI: 1275287096
Provider Name (Legal Business Name): KAREN ANNE LA ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 7TH AVE
SAINT JAMES NY
11780-2436
US

IV. Provider business mailing address

133 LOU AVE
KINGS PARK NY
11754-1522
US

V. Phone/Fax

Practice location:
  • Phone: 631-487-1627
  • Fax:
Mailing address:
  • Phone: 516-697-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number407694-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: