Basic Information
Provider Information | |||||||||
NPI: | 1376507442 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DELEO | ||||||||
FirstName: | ROSEMARY | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 145 SAWKILL RD | ||||||||
Address2: |   | ||||||||
City: | KINGSTON | ||||||||
State: | NY | ||||||||
PostalCode: | 124011226 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8458537003 | ||||||||
FaxNumber: | 8458537002 | ||||||||
Practice Location | |||||||||
Address1: | 145 SAWKILL RD | ||||||||
Address2: |   | ||||||||
City: | KINGSTON | ||||||||
State: | NY | ||||||||
PostalCode: | 124011226 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8458537003 | ||||||||
FaxNumber: | 8458537002 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/14/2006 | ||||||||
LastUpdateDate: | 04/18/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 155606-1 | NY | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | P2054745 | 01 | NY | OXFORD HEALTH PLANS | OTHER | 00892466 | 05 | NY |   | MEDICAID | 087243 | 01 | NY | MVP HEALTH PLAN | OTHER | 10031714 | 01 | NY | CDPHP | OTHER | 000494371002 | 01 | NY | BLUE SHIELD NORTHEASTERN | OTHER | 45818 | 01 | NY | GHI HMO INSURANCE | OTHER | 9X7511 | 01 | NY | EMPIRE BC/BS | OTHER |