Provider Demographics
NPI:1053755215
Name:JOSEPH, ROSE M (RN)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1880
Mailing Address - Country:US
Mailing Address - Phone:718-877-7428
Mailing Address - Fax:
Practice Address - Street 1:17 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1880
Practice Address - Country:US
Practice Address - Phone:718-877-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY594062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse