Provider Demographics
NPI:1235186164
Name:ROSSI, REGINA L (DO)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:L
Last Name:ROSSI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:L
Other - Last Name:OMRANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:195 ROUTE 9 SOUTH
Mailing Address - Street 2:STE 108
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-536-7144
Mailing Address - Fax:732-536-7520
Practice Address - Street 1:195 ROUTE 9 SOUTH
Practice Address - Street 2:STE 108
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:732-536-7144
Practice Address - Fax:732-536-7520
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06019200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8646007Medicaid
G10394Medicare UPIN
NJ8646007Medicaid