Provider Demographics
NPI:1578622650
Name:ROSENWACH, ELAINE I (FNP, CNM)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:I
Last Name:ROSENWACH
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 RIVERSIDE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4176
Mailing Address - Country:US
Mailing Address - Phone:607-770-7074
Mailing Address - Fax:607-770-3452
Practice Address - Street 1:161 RIVERSIDE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4176
Practice Address - Country:US
Practice Address - Phone:607-770-7074
Practice Address - Fax:607-770-3452
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000681367A00000X
NY330393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01668377Medicaid
NY01668377Medicaid
R56846Medicare UPIN