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General NPI Number Information
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NPI Number | 1336848670
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Entity Type | Individual
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Provider Name | LYDIA ELSIE ROSE MED
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 280 ROUTE 211 E STE 104-300
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City | MIDDLETOWN
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State | NY
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Zip | 10940-3109
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Country | US
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Telephone | 845-769-8179
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Fax | 845-913-9410
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Provider Business Mailing Address
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Address Line | 14 BRIGHTON DR UNIT 2604
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City | NEWBURGH
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State | NY
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Zip | 12550-7453
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Country | US
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Telephone | 845-549-0738
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 848459981
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License Number State | NY
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