Provider Demographics
NPI:1619420577
Name:DEL ROSARIO, CLARY
Entity type:Individual
Prefix:
First Name:CLARY
Middle Name:
Last Name:DEL ROSARIO
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 1:1082 GERARD AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8818
Mailing Address - Country:US
Mailing Address - Phone:347-925-7797
Mailing Address - Fax:
Practice Address - Street 1:1082 GERARD AVE
Practice Address - Street 2:1B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8809
Practice Address - Country:US
Practice Address - Phone:914-354-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2349688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist