Provider Demographics
NPI:1225419062
Name:ROSALES, JASMYN
Entity Type:Individual
Prefix:
First Name:JASMYN
Middle Name:
Last Name:ROSALES
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 1:3321 BRUCKNER BLVD APT 6L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5637
Mailing Address - Country:US
Mailing Address - Phone:646-644-0162
Mailing Address - Fax:
Practice Address - Street 1:243 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-7400
Practice Address - Country:US
Practice Address - Phone:252-368-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist