Provider Demographics
NPI:1174757249
Name:ROSEME-FREDERIC, NATHALIE
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:ROSEME-FREDERIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1144
Mailing Address - Country:US
Mailing Address - Phone:718-424-2788
Mailing Address - Fax:718-424-3513
Practice Address - Street 1:3508 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2609
Practice Address - Country:US
Practice Address - Phone:718-253-3900
Practice Address - Fax:718-258-7844
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine