=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467179614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAITLIN ROSSI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2022
-----------------------------------------------------
Last Update Date | 10/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 HASTINGS RD
-----------------------------------------------------
City | ISLAND PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11558-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-382-2798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 HASTINGS RD
-----------------------------------------------------
City | ISLAND PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11558-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | 829592
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------