Provider Demographics
NPI:1306868815
Name:DEL ROSARIO, EDUARDO SANTOS JR (PHD, FNP-BC)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:SANTOS
Last Name:DEL ROSARIO
Suffix:JR
Gender:M
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 4TH AVE UNIT 1393
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5213
Mailing Address - Country:US
Mailing Address - Phone:503-334-9374
Mailing Address - Fax:
Practice Address - Street 1:300 CORPORATE BLVD S
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6862
Practice Address - Country:US
Practice Address - Phone:833-637-3866
Practice Address - Fax:212-844-1503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336714363LF0000X
OR336714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR290830Medicaid
NY208VP0014XOtherDPMPC