Individual
IVAN ROSALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
191 JORALEMON ST, BROOKLYN, NY 11201-4306
(646) 623-4687
Mailing address
191 JORALEMON ST, BROOKLYN, NY 11201-4306
(646) 623-4687
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
876009166
NY
Other
Enumeration date
09/30/2014
Last updated
09/30/2014
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