Healthcare Provider Details

I. General information

NPI: 1881402626
Provider Name (Legal Business Name): KARLEY-ROSE TROTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 JERICHO TPKE
SYOSSET NY
11791-4515
US

IV. Provider business mailing address

930 N CENTRAL AVE
MASSAPEQUA NY
11758-2835
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-6400
  • Fax:
Mailing address:
  • Phone: 516-301-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number774495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: