Provider Demographics
NPI:1265677272
Name:BOSTEL, ROSEANNE M (OTR)
Entity Type:Individual
Prefix:MS
First Name:ROSEANNE
Middle Name:M
Last Name:BOSTEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NEWPORT PKWY
Mailing Address - Street 2:APT 912
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2301
Mailing Address - Country:US
Mailing Address - Phone:908-447-8345
Mailing Address - Fax:
Practice Address - Street 1:1775 BROADWAY
Practice Address - Street 2:SUITE 912
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1903
Practice Address - Country:US
Practice Address - Phone:212-757-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014267-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics