Provider Demographics
NPI:1083603419
Name:ROSARIO-LEGER, DELLANIRA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELLANIRA
Middle Name:C
Last Name:ROSARIO-LEGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 W MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2140
Mailing Address - Country:US
Mailing Address - Phone:201-225-9584
Mailing Address - Fax:
Practice Address - Street 1:701 W 179TH ST
Practice Address - Street 2:SUITE #3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6021
Practice Address - Country:US
Practice Address - Phone:212-740-1208
Practice Address - Fax:212-740-7755
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01157377Medicaid