Provider Demographics
NPI:1669845533
Name:MACANCELA, ROSA G
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:G
Last Name:MACANCELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE GUSTAVE L. LEVY PLACE, BOX 1030
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-0310
Mailing Address - Country:US
Mailing Address - Phone:212-241-7300
Mailing Address - Fax:212-289-5971
Practice Address - Street 1:1190 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-427-1540
Practice Address - Fax:212-410-7196
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310560363LA2200X
NYF310560-01363L00000X
NY708130-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse