Provider Demographics
NPI:1306155874
Name:ROSEHOUSE SURGICARE
Entity type:Organization
Organization Name:ROSEHOUSE SURGICARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVECOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-433-0044
Mailing Address - Street 1:P.O.BOX 30037
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-0037
Mailing Address - Country:US
Mailing Address - Phone:718-433-0044
Mailing Address - Fax:718-400-4644
Practice Address - Street 1:1975 LINDEN BLVD STE 107
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4004
Practice Address - Country:US
Practice Address - Phone:718-433-4644
Practice Address - Fax:718-433-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNICARE PLUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-01
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 261QH0100X
NY1777953-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty