Provider Demographics
NPI:1376626689
Name:ROSAS, AUGUSTO (MDPC)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:
Last Name:ROSAS
Suffix:
Gender:M
Credentials:MDPC
Other - Prefix:
Other - First Name:AUGUSTO
Other - Middle Name:
Other - Last Name:ROSAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:510 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2632
Mailing Address - Country:US
Mailing Address - Phone:845-343-8154
Mailing Address - Fax:
Practice Address - Street 1:510 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2632
Practice Address - Country:US
Practice Address - Phone:845-343-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107325207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00564723Medicaid
NY674591Medicare ID - Type Unspecified
NY00564723Medicaid