Provider Demographics
NPI:1811311038
Name:ROSSIELLO, MARIA (DPM,PA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ROSSIELLO
Suffix:
Gender:F
Credentials:DPM,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N HANGAR RD
Mailing Address - Street 2:SUITE 247-249
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11430-1826
Mailing Address - Country:US
Mailing Address - Phone:718-656-9500
Mailing Address - Fax:718-656-9503
Practice Address - Street 1:75 N HANGAR RD
Practice Address - Street 2:SUITE 247-249
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11430-1826
Practice Address - Country:US
Practice Address - Phone:718-656-9500
Practice Address - Fax:718-656-9503
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005252213ES0103X
NYN003212363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical