Provider Demographics
NPI:1336112606
Name:DESANTIS, ROSEMARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:
Last Name:DESANTIS
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 1:1322 ROUTE 72 W STE 201
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2486
Mailing Address - Country:US
Mailing Address - Phone:609-597-4178
Mailing Address - Fax:
Practice Address - Street 1:1322 ROUTE 72 W STE 201
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2486
Practice Address - Country:US
Practice Address - Phone:609-597-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06714000207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0033889OtherGHI
NJ660003915OtherRAILROAD MEDICARE
NJ9056602Medicaid
NJ2K1427OtherHEALTHNET
NJ223360408-061OtherQUALCARE
NJP2734040OtherOXFORD
NJP2734040OtherOXFORD
NJ063617Medicare ID - Type Unspecified