1417024712 NPI number — MS. TRICIA ANN ROSARIO MSPT

Table of content: KATHRYN FRITCHMAN (NPI 1740710383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417024712 NPI number — MS. TRICIA ANN ROSARIO MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSARIO
Provider First Name:
TRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417024712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 HALLOCK ROAD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-689-6666
Provider Business Mailing Address Fax Number:
631-689-6668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 HALLOCK ROAD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-689-6666
Provider Business Practice Location Address Fax Number:
631-689-6668
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0213871 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111449 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3940254 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43210 . This is a "CIGNA HMO ORTHONET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6697152 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87966 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: XC6679 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20079270 . This is a "ISLAND GROUP ADMINISTRATO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0012960456000290 . This is a "DOH RELATED SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 157625P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: A200810 . This is a "MDNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5607714 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4341677 . This is a "CIGNA PRO" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q10N11 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".




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