Provider Demographics
NPI:1407850894
Name:NENO, ROSA M (DO)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:NENO
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:988 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4608
Mailing Address - Country:US
Mailing Address - Phone:201-339-6111
Mailing Address - Fax:201-339-6333
Practice Address - Street 1:988 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4036
Practice Address - Country:US
Practice Address - Phone:201-339-6111
Practice Address - Fax:201-339-6333
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMB59240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5576105Medicaid
NJ101374Medicare PIN
NJ5576105Medicaid