Provider Demographics
NPI:1063414837
Name:TE-FREY, ROSIE TAN (NP)
Entity type:Individual
Prefix:MS
First Name:ROSIE
Middle Name:TAN
Last Name:TE-FREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-342-3892
Mailing Address - Fax:212-342-5262
Practice Address - Street 1:177 FORT WASHINGTON AVE
Practice Address - Street 2:MILSTEIN 7HN ROOM 126 NEW YORK PRESBYTERIAN HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-305-6003
Practice Address - Fax:212-305-0907
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF 302223-1363L00000X
NYF302223-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2523884Medicaid
NY2523884Medicaid
NYA400087190Medicare PIN
NY93N991Medicare ID - Type UnspecifiedNP