Provider Demographics
NPI:1811952245
Name:PURRAZZELLA, ROSE MARY (MD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:MARY
Last Name:PURRAZZELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2126
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-0605
Mailing Address - Country:US
Mailing Address - Phone:516-524-7753
Mailing Address - Fax:631-581-0196
Practice Address - Street 1:1000 N VILLAGE AVE
Practice Address - Street 2:MERCY MEDICAL CENTER
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1000
Practice Address - Country:US
Practice Address - Phone:516-705-2097
Practice Address - Fax:516-705-2691
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY144697207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01659136Medicaid
NYB17158Medicare UPIN
NY62D69Medicare PIN
NYA400011278Medicare PIN