Provider Demographics
NPI:1578899290
Name:ROSARIO, LESLIE A (RN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4303
Mailing Address - Country:US
Mailing Address - Phone:631-627-6368
Mailing Address - Fax:
Practice Address - Street 1:7 BALSAM DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4303
Practice Address - Country:US
Practice Address - Phone:631-627-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY809149163WA0400X, 163WC3500X, 163WE0003X, 163WC0200X
NY271304164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No164W00000XNursing Service ProvidersLicensed Practical Nurse