Provider Demographics
NPI:1073563284
Name:BOSESKI, SHERRI (APN-C)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:BOSESKI
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 RIDGE RD
Mailing Address - Street 2:APARTMENT 0
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-5340
Mailing Address - Country:US
Mailing Address - Phone:201-998-0680
Mailing Address - Fax:201-536-9047
Practice Address - Street 1:196 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1804
Practice Address - Country:US
Practice Address - Phone:201-536-9000
Practice Address - Fax:201-536-9047
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N010228900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P78596Medicare UPIN
066471Medicare ID - Type Unspecified