Provider Demographics
NPI:1083977698
Name:ROSADO, WILFREDO
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:
Last Name:ROSADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 EXECUTIVE DR # 105LL
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1718
Mailing Address - Country:US
Mailing Address - Phone:718-706-7500
Mailing Address - Fax:718-706-9595
Practice Address - Street 1:3711 35TH AVE STE 3C
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-1441
Practice Address - Country:US
Practice Address - Phone:718-706-7500
Practice Address - Fax:718-706-9595
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator