Provider Demographics
NPI:1063688471
Name:NICOLA ROSELLI
Entity Type:Organization
Organization Name:NICOLA ROSELLI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR CHT
Authorized Official - Phone:718-454-0842
Mailing Address - Street 1:61-18 190TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2724
Mailing Address - Country:US
Mailing Address - Phone:718-454-0842
Mailing Address - Fax:718-454-1704
Practice Address - Street 1:931A MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3711
Practice Address - Country:US
Practice Address - Phone:718-822-4054
Practice Address - Fax:718-454-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0053121332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ58072Medicare PIN
NY1267080002Medicare NSC