Provider Demographics
NPI:1427512763
Name:ROSARIO, JOSEPH (DNP-AGNP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:DNP-AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BILTMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7239
Mailing Address - Country:US
Mailing Address - Phone:347-203-7571
Mailing Address - Fax:
Practice Address - Street 1:1056 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3212
Practice Address - Country:US
Practice Address - Phone:347-203-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307869363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty