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General NPI Number Information
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NPI Number | 1790954790
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Entity Type | Individual
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Provider Name | ROSARY IMMORDINO L.P.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 3242 91ST ST #304
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City | EAST ELMHURST
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State | NY
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Zip | 11369-2363
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Country | US
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Telephone | 718-651-8117
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Fax | 718-478-9128
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Provider Business Mailing Address
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Address Line | 8702 30TH AVE
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City | EAST ELMHURST
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State | NY
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Zip | 11369-1431
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Country | US
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Telephone | 718-507-6843
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Fax | 718-478-9128
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 000025
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License Number State | NY
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