Provider Demographics
NPI:1861428823
Name:HAFEZI, ROSE C (AAS)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:C
Last Name:HAFEZI
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:FRISICARO POLIZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AAS
Mailing Address - Street 1:150 STAHL RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1231
Mailing Address - Country:US
Mailing Address - Phone:716-629-3400
Mailing Address - Fax:
Practice Address - Street 1:150 STAHL RD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1231
Practice Address - Country:US
Practice Address - Phone:716-629-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005681-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant