Provider Demographics
NPI:1003882606
Name:MEROLA, ROSE MARY (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARY
Last Name:MEROLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NEW PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2590
Mailing Address - Country:US
Mailing Address - Phone:908-389-5661
Mailing Address - Fax:908-301-5456
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:908-389-5661
Practice Address - Fax:908-301-5456
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA046347002080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5058643OtherAETNA HEALTHCARE
NJ93144OtherAMERIGROUP
NJ2206505OtherCIGNA BEHAVIORAL HEALTHCA
NJ2214817148-029OtherQUALCARE
NJ1096732OtherHORIZON NJ HEALTH
NJ0675516OtherCIGNA HEALTHCARE
NJ2K4300OtherHEALTHNET