Provider Demographics
NPI:1447672852
Name:ROSE MARIE WITEK RN,BSN
Entity type:Organization
Organization Name:ROSE MARIE WITEK RN,BSN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IV SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WITEK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTEED NURSE
Authorized Official - Phone:631-487-6512
Mailing Address - Street 1:109 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2824
Mailing Address - Country:US
Mailing Address - Phone:631-487-6512
Mailing Address - Fax:631-487-6512
Practice Address - Street 1:109 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2824
Practice Address - Country:US
Practice Address - Phone:631-487-6512
Practice Address - Fax:631-487-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY384875-1251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion