Provider Demographics
NPI:1760699060
Name:CARELUS, ROSELINE (NP)
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:CARELUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 LENA AVENUE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520
Mailing Address - Country:US
Mailing Address - Phone:516-662-3979
Mailing Address - Fax:516-379-4879
Practice Address - Street 1:309 LENA AVENUE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520
Practice Address - Country:US
Practice Address - Phone:516-662-3979
Practice Address - Fax:516-379-4879
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY428863163W00000X
NYF305252363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY428863OtherNY STATE LICENSE NUMBER