Provider Demographics
NPI:1487882098
Name:KOOMSON, ROSE
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:KOOMSON
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 1:247 N MACQUESTEN PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1005
Mailing Address - Country:US
Mailing Address - Phone:914-699-3948
Mailing Address - Fax:914-966-3948
Practice Address - Street 1:247 N MACQUESTEN PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1005
Practice Address - Country:US
Practice Address - Phone:914-699-3948
Practice Address - Fax:914-966-3948
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant