Provider Demographics
NPI:1487767729
Name:ROSE, GEORGIA
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:
Last Name:ROSE
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 1:123 W 93RD ST
Mailing Address - Street 2:#10C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7572
Mailing Address - Country:US
Mailing Address - Phone:212-864-3630
Mailing Address - Fax:
Practice Address - Street 1:285 W END AVE
Practice Address - Street 2:Y2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2504
Practice Address - Country:US
Practice Address - Phone:212-531-2229
Practice Address - Fax:914-462-4409
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000247-1176B00000X
NYF360267-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife