Healthcare Provider Details

I. General information

NPI: 1821943218
Provider Name (Legal Business Name): ERNESTO MORENO ROSABAL FNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7924 JAMAICA AVE
WOODHAVEN NY
11421-1801
US

IV. Provider business mailing address

PO BOX 211226
WOODHAVEN NY
11421-6226
US

V. Phone/Fax

Practice location:
  • Phone: 718-805-0037
  • Fax: 866-221-0879
Mailing address:
  • Phone: 832-404-1917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF359412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: