Healthcare Provider Details

I. General information

NPI: 1356989719
Provider Name (Legal Business Name): ROSE MARIE ELIZABETH COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MC KENDRICK RD
WALLKILL NY
12589-3731
US

IV. Provider business mailing address

94 LINCOLNDALE ACRES
WASHINGTONVILLE NY
10992-1046
US

V. Phone/Fax

Practice location:
  • Phone: 845-895-3000
  • Fax:
Mailing address:
  • Phone: 845-313-6927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344989-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: