1811952245 NPI number — DR. ROSE MARY PURRAZZELLA M.D.

Table of content: KENIA HERNANDEZ (NPI 1578236675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811952245 NPI number — DR. ROSE MARY PURRAZZELLA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURRAZZELLA
Provider First Name:
ROSE
Provider Middle Name:
MARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1811952245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JAMES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11780-0605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-524-7753
Provider Business Mailing Address Fax Number:
631-581-0196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N VILLAGE AVE
Provider Second Line Business Practice Location Address:
MERCY MEDICAL CENTER
Provider Business Practice Location Address City Name:
ROCKVILLE CENTRE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11570-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-705-2097
Provider Business Practice Location Address Fax Number:
516-705-2691
Provider Enumeration Date:
04/19/2006

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: 207ZP0102X , with the licence number:  144697 , 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: 01659136 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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