Provider Demographics
NPI:1083342125
Name:O'HARA, ROSA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DUKE AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-2010
Mailing Address - Country:US
Mailing Address - Phone:856-619-8707
Mailing Address - Fax:
Practice Address - Street 1:2 DUKE AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-2010
Practice Address - Country:US
Practice Address - Phone:856-619-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty