Provider Demographics
NPI:1811396443
Name:ROSE MARY SOKOLOW COLLETTE
Entity Type:Organization
Organization Name:ROSE MARY SOKOLOW COLLETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SOKOLOW COLLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-974-6244
Mailing Address - Street 1:141 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2348
Mailing Address - Country:US
Mailing Address - Phone:718-974-6244
Mailing Address - Fax:
Practice Address - Street 1:141 HOLLY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2348
Practice Address - Country:US
Practice Address - Phone:718-974-6244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0593017163W00000X, 163WP0200X
NY0593017N163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty