Provider Demographics
NPI:1417024712
Name:ROSARIO, TRICIA ANN (MSPT)
Entity type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:ANN
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HALLOCK ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-689-6666
Mailing Address - Fax:631-689-6668
Practice Address - Street 1:215 HALLOCK ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-689-6666
Practice Address - Fax:631-689-6668
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0213871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
111449OtherVYTRA
3940254OtherAETNA HMO
43210OtherCIGNA HMO ORTHONET
6697152OtherGHI PPO
87966OtherGHI HMO
XC6679OtherHEALTHNET
20079270OtherISLAND GROUP ADMINISTRATO
0012960456000290OtherDOH RELATED SERVICES
157625POtherHIP
A200810OtherMDNY
5607714OtherFIRST HEALTH
4341677OtherCIGNA PRO
Q10N11OtherEMPIRE BLUE CROSS BLUE SH
87966OtherGHI HMO
20079270OtherISLAND GROUP ADMINISTRATO