Provider Demographics
NPI:1194126631
Name:ZACHARIA, ROSE (NP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:ZACHARIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5539
Mailing Address - Country:US
Mailing Address - Phone:845-661-2073
Mailing Address - Fax:845-352-4207
Practice Address - Street 1:7 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5539
Practice Address - Country:US
Practice Address - Phone:845-661-2073
Practice Address - Fax:845-352-4207
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306985-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health