Provider Demographics
NPI:1689247033
Name:PARTAP, ROODAL L
Entity Type:Individual
Prefix:MR
First Name:ROODAL
Middle Name:L
Last Name:PARTAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 BELLPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-1537
Mailing Address - Country:US
Mailing Address - Phone:631-229-7610
Mailing Address - Fax:
Practice Address - Street 1:843 BELLPORT AVE
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1537
Practice Address - Country:US
Practice Address - Phone:631-229-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340416164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty