Provider Demographics
NPI:1437241650
Name:ROSNER, AUDREY K (CPNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:K
Last Name:ROSNER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2324
Mailing Address - Country:US
Mailing Address - Phone:718-253-0230
Mailing Address - Fax:718-338-1250
Practice Address - Street 1:901 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2919
Practice Address - Country:US
Practice Address - Phone:718-436-3705
Practice Address - Fax:718-435-6188
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189204163WP0200X
NYF380315363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01499009Medicaid