Provider Demographics
NPI:1548498330
Name:ROSE, LANCELOT PETER
Entity type:Individual
Prefix:
First Name:LANCELOT
Middle Name:PETER
Last Name:ROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BRONX PARK E
Mailing Address - Street 2:APT.MZI
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6711
Mailing Address - Country:US
Mailing Address - Phone:718-519-7047
Mailing Address - Fax:
Practice Address - Street 1:3000 BRONX PARK E
Practice Address - Street 2:APT.MZI
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6711
Practice Address - Country:US
Practice Address - Phone:718-519-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451151-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse