Provider Demographics
NPI:1497759997
Name:ROSSI, PATRICIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:ROSSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FORESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1129
Mailing Address - Country:US
Mailing Address - Phone:845-986-3025
Mailing Address - Fax:845-986-1393
Practice Address - Street 1:3 FORESTER AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1129
Practice Address - Country:US
Practice Address - Phone:845-986-3025
Practice Address - Fax:845-986-1393
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY137640OtherLICENSE
NJ0855804Medicaid
NJ36257OtherLICENSE NUMBER
NJC54859Medicare UPIN
NJ447715Medicare ID - Type Unspecified