Provider Demographics
NPI:1104175066
Name:ROSSER, JEANNE (LC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:ROSSER
Suffix:
Gender:F
Credentials:LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 COMMERCE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4454
Mailing Address - Country:US
Mailing Address - Phone:631-722-8880
Mailing Address - Fax:
Practice Address - Street 1:54 COMMERCE AVE
Practice Address - Street 2:STE 2
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4454
Practice Address - Country:US
Practice Address - Phone:631-722-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN