Provider Demographics
NPI:1215341128
Name:ROSATO, SUSAN MARIE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:ROSATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-6606
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:607-753-6677
Practice Address - Street 1:2805 CINCINNATUS ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATUS
Practice Address - State:NY
Practice Address - Zip Code:13040-0000
Practice Address - Country:US
Practice Address - Phone:607-863-4126
Practice Address - Fax:607-863-3455
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily