Provider Demographics
NPI:1841479086
Name:MORAN, ROSEANN (NP)
Entity type:Individual
Prefix:
First Name:ROSEANN
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OAKLEAF CT
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2223
Mailing Address - Country:US
Mailing Address - Phone:631-651-9305
Mailing Address - Fax:631-854-2347
Practice Address - Street 1:82 MIDDLE COUNTRY RD
Practice Address - Street 2:EMPLOYEE HEALTH SERVICES
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4411
Practice Address - Country:US
Practice Address - Phone:631-854-2367
Practice Address - Fax:631-854-2347
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302411363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health