Provider Demographics
NPI:1396827564
Name:ROSEGREEN, SUZANNE C (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:C
Last Name:ROSEGREEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10524 FLATLANDS 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4600
Mailing Address - Country:US
Mailing Address - Phone:917-923-3946
Mailing Address - Fax:718-547-4773
Practice Address - Street 1:MMC - DEPT. OF SURGERY
Practice Address - Street 2:111 EAST 210TH STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S62253Medicare UPIN
OF0571Medicare ID - Type Unspecified