Provider Demographics
NPI:1508880097
Name:DIAZ, ROSANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WESCOTT DRIVE
Mailing Address - Street 2:SUITE G3
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-788-1710
Mailing Address - Fax:908-788-1716
Practice Address - Street 1:1100 WESCOTT DRIVE
Practice Address - Street 2:SUITE G3
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-788-1710
Practice Address - Fax:908-788-1716
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00134600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant