Provider Demographics
NPI:1285650523
Name:ROSE, ELIZABETH (MD,)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CLAREMONT RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2262
Mailing Address - Country:US
Mailing Address - Phone:908-953-8336
Mailing Address - Fax:908-953-8339
Practice Address - Street 1:75 CLAREMONT RD
Practice Address - Street 2:SUITE 307
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2262
Practice Address - Country:US
Practice Address - Phone:908-953-8336
Practice Address - Fax:908-953-8339
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0535142080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1577603Medicaid
NJ031427Medicare ID - Type Unspecified
NJH03935Medicare UPIN