Provider Demographics
NPI:1346308137
Name:ROTELLA, ALESSANDRA
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:
Last Name:ROTELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 BELLASONIA COURT
Mailing Address - Street 2:
Mailing Address - City:MUTTONTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2165 BELLASONIA CT
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-9604
Practice Address - Country:US
Practice Address - Phone:516-677-6088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics