Provider Demographics
NPI:1275940488
Name:ROSARIO, MARCUS (LAC, LMBT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:LAC, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1958
Mailing Address - Country:US
Mailing Address - Phone:973-780-1888
Mailing Address - Fax:
Practice Address - Street 1:685 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1630
Practice Address - Country:US
Practice Address - Phone:973-780-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00107600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist