Provider Demographics
NPI:1497116537
Name:ROSERO, JAIME (DPT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ROSERO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WATERS PL STE 501
Mailing Address - Street 2:WSPT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2732
Mailing Address - Country:US
Mailing Address - Phone:718-409-9444
Mailing Address - Fax:
Practice Address - Street 1:1250 WATERS PL STE 501
Practice Address - Street 2:WSPT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2732
Practice Address - Country:US
Practice Address - Phone:718-409-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist