Provider Demographics
NPI:1760480370
Name:ROSATO, ANGELO CARMEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:CARMEN
Last Name:ROSATO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1037
Mailing Address - Country:US
Mailing Address - Phone:315-266-0010
Mailing Address - Fax:315-266-0147
Practice Address - Street 1:600 FRENCH RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1037
Practice Address - Country:US
Practice Address - Phone:315-266-0010
Practice Address - Fax:315-266-0147
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010651-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02292717Medicaid
NY02292717Medicaid