Provider Demographics
NPI:1326871393
Name:MIGUEL, ROSSANA
Entity type:Individual
Prefix:MS
First Name:ROSSANA
Middle Name:
Last Name:MIGUEL
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 1:569 MARTENSE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1835
Mailing Address - Country:US
Mailing Address - Phone:551-340-9990
Mailing Address - Fax:
Practice Address - Street 1:1345 AVENUE OF THE AMERICAS FL 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10105-0021
Practice Address - Country:US
Practice Address - Phone:212-981-1977
Practice Address - Fax:646-786-4026
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48681-01225100000X
NY13325-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist