Provider Demographics
NPI:1689080434
Name:ROSARIO-DIAZ, SULEIMA (APN)
Entity Type:Individual
Prefix:MS
First Name:SULEIMA
Middle Name:
Last Name:ROSARIO-DIAZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GARWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07027-1214
Mailing Address - Country:US
Mailing Address - Phone:201-792-0453
Mailing Address - Fax:
Practice Address - Street 1:152 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1115
Practice Address - Country:US
Practice Address - Phone:732-382-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00505800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health