Provider Demographics
NPI:1689915407
Name:ROSCINO, LORI (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:ROSCINO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LUELANN DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-5613
Mailing Address - Country:US
Mailing Address - Phone:845-236-3239
Mailing Address - Fax:
Practice Address - Street 1:30 LUELANN DR
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-5613
Practice Address - Country:US
Practice Address - Phone:845-236-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003603171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor