Individual
ROSALIE BANOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
565 ROUTE 25A STE 209, MILLER PLACE, NY 11764-2600
(631) 445-6881
(631) 849-4926
Mailing address
23 ROCKLEDGE DR., SHIRLEY, NY 11967
(631) 445-6881
(631) 729-3484
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400724
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330804
REGISTERED NURSE
NY
01
—
F400724
PSYCH NURSE PRACT. LIC
NY
Enumeration date
09/14/2006
Last updated
03/07/2023
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