1487637450 NPI number — MARIANNE ROOSELS MD

Table of content: MARIANNE ROOSELS MD (NPI 1487637450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487637450 NPI number — MARIANNE ROOSELS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROOSELS
Provider First Name:
MARIANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487637450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8519
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BANK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701-8519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-460-9840
Provider Business Mailing Address Fax Number:
732-460-9848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 PINCKNEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BANK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07701-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-747-4600
Provider Business Practice Location Address Fax Number:
732-219-1968
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0K4740 . This is a "HEALTH NET OF THE NE INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44D311 . This is a "EMPIRE BC BS OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6959575 . This is a "CIGNA HEALTHCARE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 11208 . This is a "AETNA HEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1225405 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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