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NPI Code Detail

MEDICARE: MRS. ROSE CASSIDY N.P.

MEDICARE: MRS. ROSE CASSIDY N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerF300869NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
196V361OTHERNJBCBS

General Provider Information

NPI Number : 1215049309
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROSE CASSIDY N.P.
Provider Business Mailing Address
First Line : 915 HILLSIDE AVE
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11040-2529
Country : US
Telephone Number : 516-437-9660
Fax Number : 516-328-9355
Provider Business Practice Location Address
First Line : 915 HILLSIDE AVE
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11040-2529
Country : US
Telephone Number : 516-437-9660
Fax Number : 516-328-9355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. ROSE CASSIDY N.P.” Practice Location

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