Individual
ROSALIA CASANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
139 QUEEN ST, BAY SHORE, NY 11706-1820
(631) 676-7675
(631) 676-7675
Mailing address
139 QUEEN ST, BAY SHORE, NY 11706-1820
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
006897
NY
Other
Enumeration date
04/07/2011
Last updated
09/21/2011
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