Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 048500 | NY |
NPI | 1013048032 |
---|---|
Provider Name | Dr. Jeffrey Christian Rosario |
First Address | Commack, NY 11725-3405 |
Second Address | Commack, NY 11725-3405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |