Provider Demographics
NPI:1699013011
Name:ROTONDO VENET, SAMANTHA ANGEL (APN-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANGEL
Last Name:ROTONDO VENET
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RAIDER BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1528
Mailing Address - Country:US
Mailing Address - Phone:908-281-0221
Mailing Address - Fax:908-281-0940
Practice Address - Street 1:105 RAIDER BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1528
Practice Address - Country:US
Practice Address - Phone:908-281-0221
Practice Address - Fax:908-281-0940
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00414500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health