Provider Demographics
NPI:1932141363
Name:ROSEDALE PSYCHIATRY PA
Entity Type:Organization
Organization Name:ROSEDALE PSYCHIATRY PA
Other - Org Name:ZOFIA BOCHACKI M.D
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPYTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-992-1359
Mailing Address - Street 1:19208 HIDDEN COVE LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7596
Mailing Address - Country:US
Mailing Address - Phone:704-896-5579
Mailing Address - Fax:
Practice Address - Street 1:10225 HICKORYWOOD HILL AVE
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3307
Practice Address - Country:US
Practice Address - Phone:704-992-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2281196AOtherIND. MEDICARE PROVIDER NO
NCF66750Medicare UPIN
NC2281196AOtherIND. MEDICARE PROVIDER NO