Provider Demographics
NPI:1861451775
Name:WATMAN, ROSALIND (DO)
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:WATMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CAUMSETT FARMS LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1243
Mailing Address - Country:US
Mailing Address - Phone:516-637-9731
Mailing Address - Fax:
Practice Address - Street 1:11 CAUMSETT FARMS LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1243
Practice Address - Country:US
Practice Address - Phone:516-637-9731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166543207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01507684Medicaid
NYF93534Medicare UPIN
NY63J501Medicare PIN