Individual provider Active NPI

Rose C. Ubanwa, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Forest Hills, NY
National Provider Identifier
1831409861
Registry record updated Nov 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
404175 Issued in NY
Practice address
11835 Queens Blvd FL 6
Forest Hills, NY 11375-7211
Phone
(718) 651-7770
NPI assigned
Oct 8, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 336512 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 404175 NY Primary

Addresses

Primary practice location

11835 Queens Blvd FL 6
Forest Hills, NY 11375-7211

Mailing address

11835 Queens Blvd FL 6
Forest Hills, NY 11375-7211
Phone (718) 651-7770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140724002575 NY Practitioner - Nurse Practitioner 8628200292 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Child Center of Ny IncGroup PAC ID 8426010638, 15 clinicians

Practice addresses (Care Compare)

4308 52ND St
FL 2
Woodside, NY 11377-4542
Phone (718) 651-7770

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
336512NYMDFamily Nurse Practitioner
404175NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
NYU Langone Hospitals CurrentSince Jan 17, 2017 Accepting new patients
The Child Center of Ny, Inc. CurrentSince Jan 22, 2024 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
NYU Langone Hospitals CurrentSince Jan 17, 2017 Accepting new patients
Optum Urgent Care, PLLC CurrentSince Mar 1, 2020 Accepting new patients
NYU Lutheran Medical Center Past Accepting new patients

Locations

150 55th St
Rm 3618
Brooklyn, NY 11220
Phone (718) 630-7477

3414 Church Ave
Brooklyn, NY 11203
Phone (718) 630-2197

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

11835 Queens Blvd
Fl 6
Forest Hills, NY 11375
Phone (718) 851-7770

555 N Broadway
Jericho, NY 11753
Phone (516) 597-5070

2800 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 622-6131

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

201A E 124th St
New York, NY 10035
Phone (212) 831-5020

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1831409861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD FL 6",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757211",
            "telephone_number": "718-651-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD FL 6",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757211",
            "telephone_number": "718-651-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UBANWA",
        "first_name": "ROSE",
        "middle_name": "C.",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-08",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "336512",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.