1578622650 NPI number — ELAINE I ROSENWACH F.N.P., C.N.M.

Table of content: ELAINE I ROSENWACH F.N.P., C.N.M. (NPI 1578622650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578622650 NPI number — ELAINE I ROSENWACH F.N.P., C.N.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENWACH
Provider First Name:
ELAINE
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F.N.P., C.N.M.
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:
1578622650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 RIVERSIDE DR
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
BINGHAMTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13905-4176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-770-7074
Provider Business Mailing Address Fax Number:
607-770-3452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
BINGHAMTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13905-4176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-770-7074
Provider Business Practice Location Address Fax Number:
607-770-3452
Provider Enumeration Date:
12/06/2006

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: 367A00000X , with the licence number:  000681 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 330393 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01668377 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com