Basic Information
| Provider Information | |||||||||
| NPI: | 1194144402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSALES | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | CLAUDINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 W 168TH ST # 4 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5456018846 | ||||||||
| FaxNumber: | 2123052843 | ||||||||
| Practice Location | |||||||||
| Address1: | 177 FORT WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123055138 | ||||||||
| FaxNumber: | 2123052843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 289611 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.