1932589454 NPI number — ROSELYN A. ROXAS PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932589454 NPI number — ROSELYN A. ROXAS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROXAS
Provider First Name:
ROSELYN
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROXAS
Provider Other First Name:
ROSELYN
Provider Other Middle Name:
ARROJADO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932589454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 ROUTE 73
Provider Second Line Business Mailing Address:
VOORHEES
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-9573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-809-3559
Provider Business Mailing Address Fax Number:
856-809-3573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 E EVESHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-9509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-482-4451
Provider Business Practice Location Address Fax Number:
856-985-8365
Provider Enumeration Date:
06/01/2015

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: 225100000X , with the licence number:  40QA00500100 , 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: R6904 67161 55622 . This is a "NJ DRIVER'S LICENSE NO." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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