Provider Demographics
NPI:1093832099
Name:KOSSEFF-SALCHERT, RONDA DEBRA
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:DEBRA
Last Name:KOSSEFF-SALCHERT
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 1:415 SEPASCO CENTER ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-2240
Mailing Address - Country:US
Mailing Address - Phone:845-876-2958
Mailing Address - Fax:
Practice Address - Street 1:301 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2586
Practice Address - Country:US
Practice Address - Phone:845-473-8856
Practice Address - Fax:845-473-3751
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007435-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02831698Medicaid
NY02831698Medicaid