Provider Demographics
NPI:1558425116
Name:D'ANDREA, ROSANNE (LMT, LAC)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:D'ANDREA
Suffix:
Gender:F
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3018
Mailing Address - Country:US
Mailing Address - Phone:718-420-3731
Mailing Address - Fax:718-420-3731
Practice Address - Street 1:330 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3941
Practice Address - Country:US
Practice Address - Phone:718-356-9222
Practice Address - Fax:718-605-4729
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002656-1171100000X
NY014197-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist