Provider Demographics
NPI:1760812630
Name:MCINTYRE, ROSEMARIE (OTA)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HOPKINS COMMONS
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-2014
Mailing Address - Country:US
Mailing Address - Phone:516-318-7296
Mailing Address - Fax:
Practice Address - Street 1:18 HOPKINS COMMONS
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-2014
Practice Address - Country:US
Practice Address - Phone:516-318-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007683-01172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty