Provider Demographics
NPI:1528600715
Name:ROSEVILLE HEALTH CENTER INC.
Entity Type:Organization
Organization Name:ROSEVILLE HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-614-3040
Mailing Address - Street 1:500 ORANGE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2944
Mailing Address - Country:US
Mailing Address - Phone:201-614-3040
Mailing Address - Fax:201-614-2423
Practice Address - Street 1:500 ORANGE ST FL 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2944
Practice Address - Country:US
Practice Address - Phone:201-614-3040
Practice Address - Fax:201-614-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty