Provider Demographics
NPI:1447279211
Name:CORDA, ROZELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ROZELLE
Middle Name:
Last Name:CORDA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-342-3892
Mailing Address - Fax:212-342-5262
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:2-274N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-5975
Practice Address - Fax:212-305-4408
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02919588Medicaid
NY98V561Medicare PIN