Provider Demographics
NPI:1336126630
Name:ROSATI, ANDREA MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIE
Last Name:ROSATI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-332-3525
Practice Address - Street 1:5290 MILITARY RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1953
Practice Address - Country:US
Practice Address - Phone:716-297-9379
Practice Address - Fax:716-297-4238
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420250-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512087OtherIHA
NY040426003574OtherFIDELIS
NY00020169901OtherUNIVERA
NY000560203001OtherBLUE CROSS OF WNY
NY01867110Medicaid
NY7599869OtherGHI
NY01867110Medicaid
NY7599869OtherGHI
NY077041Medicare Oscar/Certification