| Doctor Name: | ROSALIE BANOVICH |
| NPI Number: | 1306941026 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NPP |
| License Number: | F400724 |
| Business Practice Address: | 565 Route 25a Ste 209 Miller Place, NY - 117642600 |
| Business Phone Number: | 6314456881 |
| Business Fax Number: | 6318494926 |
| Mailing Address: | 23 Rockledge Dr., SHIRLEY |
| State: | NY |
| Postal Code: | 11967 |
| Phone Number: | 6314456881 |
| Fax Number: | 6317293484 |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 03/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | F400724 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |