Provider Demographics
NPI:1952553505
Name:ROHAN-CASSIDY, ANN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:ROHAN-CASSIDY
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 1:18 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3818
Mailing Address - Country:US
Mailing Address - Phone:516-317-1174
Mailing Address - Fax:516-797-8184
Practice Address - Street 1:18 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3818
Practice Address - Country:US
Practice Address - Phone:516-317-1174
Practice Address - Fax:516-797-8184
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333108-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily