Provider Demographics
NPI:1750683744
Name:REGILUS, ROSELORE
Entity Type:Individual
Prefix:
First Name:ROSELORE
Middle Name:
Last Name:REGILUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-2058
Mailing Address - Country:US
Mailing Address - Phone:908-659-8745
Mailing Address - Fax:
Practice Address - Street 1:1143 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-2058
Practice Address - Country:US
Practice Address - Phone:908-659-8745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296886164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse