Provider Demographics
NPI:1417622002
Name:BAYRON, ROSE NELLIE
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:NELLIE
Last Name:BAYRON
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 1:1675 METROPOLITAN AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6288
Mailing Address - Country:US
Mailing Address - Phone:917-259-9678
Mailing Address - Fax:
Practice Address - Street 1:JOHN F. KENNEDY INTERNATIONAL AIRPORT
Practice Address - Street 2:TERMINAL 4
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11430-1143
Practice Address - Country:US
Practice Address - Phone:718-751-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025635225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist