Provider Demographics
NPI:1013191592
Name:DAVIS, ROSE E (PA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3906
Mailing Address - Country:US
Mailing Address - Phone:732-777-9620
Mailing Address - Fax:
Practice Address - Street 1:225 E 53RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4809
Practice Address - Country:US
Practice Address - Phone:212-829-1200
Practice Address - Fax:212-829-1070
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005413-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical