Provider Demographics
NPI:1376507442
Name:DELEO, ROSEMARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:A
Last Name:DELEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SAWKILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1226
Mailing Address - Country:US
Mailing Address - Phone:845-853-7003
Mailing Address - Fax:845-853-7002
Practice Address - Street 1:145 SAWKILL RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1226
Practice Address - Country:US
Practice Address - Phone:845-853-7003
Practice Address - Fax:845-853-7002
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155606-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2054745OtherOXFORD HEALTH PLANS
NY00892466Medicaid
NY087243OtherMVP HEALTH PLAN
NY10031714OtherCDPHP
NY000494371002OtherBLUE SHIELD NORTHEASTERN
NY45818OtherGHI HMO INSURANCE
NY9X7511OtherEMPIRE BC/BS
NY45818OtherGHI HMO INSURANCE
NY42D591Medicare ID - Type UnspecifiedMEDICARE