1770167660 NPI number — JOANNA MICHELE ROSE NP

Table of content: JOANNA MICHELE ROSE NP (NPI 1770167660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770167660 NPI number — JOANNA MICHELE ROSE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSE
Provider First Name:
JOANNA
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMANN
Provider Other First Name:
JOANNA
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770167660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
276 WOODLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANORVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11949-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-835-6078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 VETERANS MEMORIAL HWY STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11725-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-498-1344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2021

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: 363LF0000X , with the licence number:  F338740-01 , 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)