=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902074891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSANNE BRIDGET-AGNES HIRSCH RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2008
-----------------------------------------------------
Last Update Date | 02/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 182 SOUTH LONG BEACH ROAD
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-594-0213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 SOUTH LONG BEACH ROAD
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-594-0213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 4581611
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------