Provider Demographics
NPI:1407104433
Name:PLENOS, ROSEMARIE
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:PLENOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 GROVE ST
Mailing Address - Street 2:UNIT C9
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3173
Mailing Address - Country:US
Mailing Address - Phone:973-652-7796
Mailing Address - Fax:
Practice Address - Street 1:575 GROVE ST UNIT C9
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3175
Practice Address - Country:US
Practice Address - Phone:973-652-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA00961300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist