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General NPI Number Information
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NPI Number | 1013787621
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Entity Type | Individual
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Provider Name | MARILYN ROSA
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Gender | Female
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 1031 ELM ST
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City | PEEKSKILL
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State | NY
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Zip | 10566-3401
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Country | US
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Telephone | 914-739-0093
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Fax |
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Provider Business Mailing Address
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Address Line | 2 PATAKI FARM RD
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City | PEEKSKILL
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State | NY
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Zip | 10566-6102
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Country | US
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Telephone | 917-536-2704
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 033296
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License Number State | NY
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