Provider Demographics
NPI:1437411295
Name:SARKAR, ROSEANNE (LAC)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:SARKAR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MOONACHIE
Mailing Address - State:NJ
Mailing Address - Zip Code:07074-1306
Mailing Address - Country:US
Mailing Address - Phone:551-206-2830
Mailing Address - Fax:
Practice Address - Street 1:349 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MOONACHIE
Practice Address - State:NJ
Practice Address - Zip Code:07074-1306
Practice Address - Country:US
Practice Address - Phone:551-206-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00090200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist