Provider Demographics
NPI:1497170120
Name:MCCANN, ROSY
Entity Type:Individual
Prefix:
First Name:ROSY
Middle Name:
Last Name:MCCANN
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 1:305 W GRAND AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1813
Mailing Address - Country:US
Mailing Address - Phone:201-391-8282
Mailing Address - Fax:201-391-8299
Practice Address - Street 1:305 W GRAND AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1813
Practice Address - Country:US
Practice Address - Phone:201-391-8282
Practice Address - Fax:201-391-8299
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ68423105133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education