Provider Demographics
NPI:1164795266
Name:MEJIA, ROSEMARIE
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:MEJIA
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 1:6 EXPRESSWAY DR S
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1930
Mailing Address - Country:US
Mailing Address - Phone:631-891-5401
Mailing Address - Fax:
Practice Address - Street 1:6 EXPRESSWAY DR S
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1930
Practice Address - Country:US
Practice Address - Phone:631-891-5401
Practice Address - Fax:631-891-5401
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY802258-01163W00000X
NY297294164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse