MEDICARE: DR. WAYNE ROSSI DC

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
1	111N00000X	Chiropractor	X0031551	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350038658	OTHER	NY	EMPIRE BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1215924436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE ROSSI DC

Provider Business Mailing Address
First Line	:	214 RONALD REAGAN BLVD
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-4107
Country	:	US
Telephone Number	:	845-986-2323
Fax Number	:	845-987-1950

Provider Business Practice Location Address
First Line	:	214 RONALD REAGAN BLVD
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-4107
Country	:	US
Telephone Number	:	845-986-2323
Fax Number	:	845-987-1950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	11/05/2010

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Directions to “ DR. WAYNE ROSSI DC” Practice Location

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