Basic Information
| Provider Information | |||||||||
| NPI: | 1457519563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUSACK | ||||||||
| FirstName: | ROSLYN | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNC NIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 EAST 68TH STREET | ||||||||
| Address2: | NEW YORK PRESBYTERIAN HOSPITAL-CORNELL WEILL DIVISION | ||||||||
| City: | NYC | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127460318 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 525 EAST 68TH STREET | ||||||||
| Address2: | NEW YORK PRESBYTERIAN HOSPITAL | ||||||||
| City: | NYC | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127460318 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2008 | ||||||||
| LastUpdateDate: | 05/28/2008 | ||||||||
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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 | 163W00000X | 263643 | NY | N | Nursing Service Providers | Registered Nurse | 163W00000X | 078013 | CT | N | Nursing Service Providers | Registered Nurse | 163WN0002X | 263643 | NY | Y | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care |
No ID Information.