Provider Demographics
NPI:1215038146
Name:GRABOSO, REBECCA DELEON (DNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DELEON
Last Name:GRABOSO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 AVENUE AT THE CMN STE 1
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4570
Mailing Address - Country:US
Mailing Address - Phone:848-226-5595
Mailing Address - Fax:866-493-2616
Practice Address - Street 1:160 AVENUE AT THE CMN STE 1
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4570
Practice Address - Country:US
Practice Address - Phone:848-226-5595
Practice Address - Fax:866-493-2616
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00101400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123890XVAMedicare UPIN