Provider Demographics
NPI:1548448244
Name:BASILE-SZULC, ROSEMARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:
Last Name:BASILE-SZULC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-4624
Mailing Address - Country:US
Mailing Address - Phone:718-983-8872
Mailing Address - Fax:719-983-0348
Practice Address - Street 1:242 MASON AVE
Practice Address - Street 2:
Practice Address - City:STATEN STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-983-8872
Practice Address - Fax:718-983-0348
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014735103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL87471Medicare PIN