Provider Demographics
NPI:1972561777
Name:INDELICATO, ROSE A (ANP)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:A
Last Name:INDELICATO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:SZKAKANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-0819
Mailing Address - Country:US
Mailing Address - Phone:914-637-1357
Mailing Address - Fax:
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5503
Practice Address - Country:US
Practice Address - Phone:914-632-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301517363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02054566Medicaid
NY93N511Medicare PIN
NY02054566Medicaid