Provider Demographics
NPI:1295524007
Name:ROSA, JEFFREY (RN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ROSA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ROSALIE CT
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1509
Mailing Address - Country:US
Mailing Address - Phone:516-306-6399
Mailing Address - Fax:
Practice Address - Street 1:69 ROSALIE CT
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1509
Practice Address - Country:US
Practice Address - Phone:516-306-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY539344163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine