Provider Demographics
NPI:1497311047
Name:OPTIMUM MENS HEALTH LLC
Entity Type:Organization
Organization Name:OPTIMUM MENS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, AGNP
Authorized Official - Phone:631-486-9100
Mailing Address - Street 1:1056 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3212
Mailing Address - Country:US
Mailing Address - Phone:631-486-9100
Mailing Address - Fax:631-486-9102
Practice Address - Street 1:1056 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3212
Practice Address - Country:US
Practice Address - Phone:631-486-9100
Practice Address - Fax:631-486-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1346682739Medicaid
NY1427512763Medicaid