Provider Demographics
NPI:1225076490
Name:ROSSETTI, NICOLAS ANTHONY (NP)
Entity Type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:ANTHONY
Last Name:ROSSETTI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W 36TH ST
Mailing Address - Street 2:FL 9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7529
Mailing Address - Country:US
Mailing Address - Phone:646-625-3041
Mailing Address - Fax:646-503-2952
Practice Address - Street 1:229 W 36TH ST
Practice Address - Street 2:FL 9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7529
Practice Address - Country:US
Practice Address - Phone:646-625-3041
Practice Address - Fax:646-503-2952
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03416240Medicaid
NYA400085212Medicare PIN