Provider Demographics
NPI:1386817518
Name:MOJARES, ROSE MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROSE MICHELLE
Middle Name:
Last Name:MOJARES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SIRE STAKES DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2879
Mailing Address - Country:US
Mailing Address - Phone:732-544-1533
Mailing Address - Fax:
Practice Address - Street 1:47 MAPLE ST
Practice Address - Street 2:SUITE 406
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2571
Practice Address - Country:US
Practice Address - Phone:908-918-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00143200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant