Provider Demographics
NPI:1154379675
Name:ROZMUS, IRENE P (ANP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:P
Last Name:ROZMUS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3332
Mailing Address - Country:US
Mailing Address - Phone:716-675-3754
Mailing Address - Fax:716-675-7110
Practice Address - Street 1:1900 RIDGE RD
Practice Address - Street 2:MEDICAL ASSOCIATES SOUTHTOWNS PC
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-675-3754
Practice Address - Fax:716-675-7110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300178207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
00010006101OtherUNIVERA
2208474OtherIHA
2208474OtherIHA
CC1397Medicare ID - Type Unspecified