Provider Demographics
NPI:1487637450
Name:ROOSELS, MARIANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:ROOSELS
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:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:27 PINCKNEY RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2106
Practice Address - Country:US
Practice Address - Phone:732-747-4600
Practice Address - Fax:732-219-1968
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0K4740OtherHEALTH NET OF THE NE INC
NY44D311OtherEMPIRE BC BS OF NY
NJ6959575OtherCIGNA HEALTHCARE OF NJ
11208OtherAETNA HEALTH HMO
NJ1225405Medicaid
C52553Medicare UPIN
462242DCHMedicare ID - Type Unspecified