Provider Demographics
NPI:1023384534
Name:ROSARIO-HEBER, IDA D (RN)
Entity Type:Individual
Prefix:PROF
First Name:IDA
Middle Name:D
Last Name:ROSARIO-HEBER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 45TH ST
Mailing Address - Street 2:APT # 5G
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1054
Mailing Address - Country:US
Mailing Address - Phone:917-804-4442
Mailing Address - Fax:718-361-5631
Practice Address - Street 1:4810 31ST AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11103-1334
Practice Address - Country:US
Practice Address - Phone:718-721-5404
Practice Address - Fax:718-728-3478
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY371942163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice