Provider Demographics
NPI:1053641662
Name:ROSE, KARLENE
Entity Type:Individual
Prefix:
First Name:KARLENE
Middle Name:
Last Name:ROSE
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 1:510 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1147
Mailing Address - Country:US
Mailing Address - Phone:516-437-6050
Mailing Address - Fax:516-437-6304
Practice Address - Street 1:510 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1147
Practice Address - Country:US
Practice Address - Phone:516-437-6050
Practice Address - Fax:516-437-6304
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666971Medicaid