Provider Demographics
NPI:1891836805
Name:GANOZA, ROSA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:GANOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5013
Mailing Address - Country:US
Mailing Address - Phone:631-656-9408
Mailing Address - Fax:
Practice Address - Street 1:440 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5013
Practice Address - Country:US
Practice Address - Phone:631-656-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY525659120OtherLEARNER PERMIT
NY0744567OtherSUFFOLK COMMUNITY COLLEGE