=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215140645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANA IRIS ROSARIO D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 436 FORT WASHINGTON AVE SUITE 1F
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10033-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-795-5200
-----------------------------------------------------
Fax | 212-202-6101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 HEMPTOR RD
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-2509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-795-5200
-----------------------------------------------------
Fax | 212-202-6101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 044436
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------