Provider Demographics
NPI:1740818491
Name:NICOLA ROSELLI
Entity type:Organization
Organization Name:NICOLA ROSELLI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OTRCHT
Authorized Official - Phone:718-454-0842
Mailing Address - Street 1:5847 FRANCIS LEWIS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1601
Mailing Address - Country:US
Mailing Address - Phone:718-454-0842
Mailing Address - Fax:718-454-1704
Practice Address - Street 1:140 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5511
Practice Address - Country:US
Practice Address - Phone:718-454-0842
Practice Address - Fax:718-454-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ58072OtherMEDICARE