Provider Demographics
NPI:1093135873
Name:MARY ROSEO'BRIEN
Entity Type:Organization
Organization Name:MARY ROSEO'BRIEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY ROSE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-275-6119
Mailing Address - Street 1:35 W 53RD ST
Mailing Address - Street 2:APARTMENT 2F
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4169
Mailing Address - Country:US
Mailing Address - Phone:201-275-6119
Mailing Address - Fax:
Practice Address - Street 1:35 W 53RD ST
Practice Address - Street 2:APARTMENT 2F
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4169
Practice Address - Country:US
Practice Address - Phone:201-275-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY547663-1251J00000X
NJ26NR11243900251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care