Provider Demographics
NPI:1992107940
Name:GENAO-DELGADO, ROSA
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:
Last Name:GENAO-DELGADO
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 1:44 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6801
Mailing Address - Country:US
Mailing Address - Phone:914-262-5032
Mailing Address - Fax:
Practice Address - Street 1:44 WALNUT LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6801
Practice Address - Country:US
Practice Address - Phone:914-262-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338334305171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator