Provider Demographics
NPI:1023371390
Name:THORN, ROSEANN (MSED)
Entity Type:Individual
Prefix:MS
First Name:ROSEANN
Middle Name:
Last Name:THORN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 BATHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5928
Mailing Address - Country:US
Mailing Address - Phone:718-367-5917
Mailing Address - Fax:718-367-6692
Practice Address - Street 1:2465 BATHGATE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5928
Practice Address - Country:US
Practice Address - Phone:718-367-5917
Practice Address - Fax:718-367-6692
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist