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General NPI Number Information
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NPI Number | 1447672852
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Entity Type | Organization
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Legal Business Name | ROSE MARIE WITEK RN,BSN
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 109 VIRGINIA AVE
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City | LAKE GROVE
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State | NY
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Zip | 11755-2824
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Country | US
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Telephone | 631-487-6512
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Fax | 631-487-6512
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Provider Business Mailing Address
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Address Line | 109 VIRGINIA AVE
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City | LAKE GROVE
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State | NY
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Zip | 11755-2824
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Country | US
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Telephone | 631-487-6512
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Fax | 631-487-6512
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Authorized Official
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Title or Position | IV SPECIALIST
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Name | MS. ROSE MARIE WITEK
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Credential | REGISTEED NURSE
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Telephone | 631-487-6512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 384875-1
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License Number State | NY
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