Provider Demographics
NPI:1558308890
Name:ROHAN, ANNIE (PHD, RNC, NNP/PNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:
Last Name:ROHAN
Suffix:
Gender:F
Credentials:PHD, RNC, NNP/PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EQUESTRIAN CT
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1848
Mailing Address - Country:US
Mailing Address - Phone:631-689-1438
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK HOSPITAL
Practice Address - Street 2:NICU/LEVEL 5
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350017363LN0000X, 363LN0005X
NYF380555363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043263Medicaid