Provider Demographics
NPI:1689029985
Name:FLOM CISNEROS, ROSEMARIE (LAC)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:FLOM CISNEROS
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 1:38 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1832
Mailing Address - Country:US
Mailing Address - Phone:917-407-2292
Mailing Address - Fax:
Practice Address - Street 1:38 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1832
Practice Address - Country:US
Practice Address - Phone:917-407-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005657-1171100000X
NJ25MZ00115300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist