Provider Demographics
NPI:1437247814
Name:CEBELENSKI, ROSANNE M (DO)
Entity Type:Individual
Prefix:MS
First Name:ROSANNE
Middle Name:M
Last Name:CEBELENSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5211
Mailing Address - Country:US
Mailing Address - Phone:631-253-7005
Mailing Address - Fax:631-667-9411
Practice Address - Street 1:1644 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5211
Practice Address - Country:US
Practice Address - Phone:631-253-7005
Practice Address - Fax:631-667-9411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202315173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG82851Medicare UPIN
NY9X3041Medicare ID - Type Unspecified
NY9X3041Medicare UPIN