Provider Demographics
NPI:1225612856
Name:DIMACULANGAN, ROSELYN (RN)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:
Last Name:DIMACULANGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CANNON PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4302
Mailing Address - Country:US
Mailing Address - Phone:718-796-8100
Mailing Address - Fax:
Practice Address - Street 1:3400 CANNON PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4302
Practice Address - Country:US
Practice Address - Phone:718-796-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY515369163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse