MEDICARE: NICOLA ROSELLI

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	332BC3200X	Customized Equipment (DME)	0053121	NY

General Provider Information

NPI Number	:	1851558878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLA ROSELLI

Provider Business Mailing Address
First Line	:	5847 FRANCIS LEWIS BLVD STE 200
Second Line	:
City	:	OAKLAND GDNS
State	:	NY
Zip	:	11364-1601
Country	:	US
Telephone Number	:	718-454-0842
Fax Number	:	718-454-1704

Provider Business Practice Location Address
First Line	:	5847 FRANCIS LEWIS BLVD STE 200
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-1601
Country	:	US
Telephone Number	:	718-454-0842
Fax Number	:	718-454-1704

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. NICOLA ROSELLI
Credential	:	OTR CHT
Telephone Number	:	718-454-0842

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	06/11/2024

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Practice Location Address:

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Practice Fax: 718-454-1704

Directions to “NICOLA ROSELLI ” Practice Location

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