Provider Demographics
NPI:1275173767
Name:ROSAS, NANCY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:ROSAS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:2500 ROUTE 347 BLDG 6D
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 ROUTE 347 BLDG 6D
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2552
Practice Address - Country:US
Practice Address - Phone:631-675-1895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist