=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083971568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GIACOMA ROSA GATTUSO REGISTERED NURSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2012
-----------------------------------------------------
Last Update Date | 04/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38-09 28 ST 11 FL
-----------------------------------------------------
City | LONG ISLAND CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11101-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-960-8340
-----------------------------------------------------
Fax | 347-396-4767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42-09 28TH ST. 11TH FLOOR
-----------------------------------------------------
City | LONG ISLAND CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-960-8340
-----------------------------------------------------
Fax | 347-396-4767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Registered Nurse
-----------------------------------------------------
License Number | 458885-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------