Provider Demographics
NPI:1780671214
Name:ROSES MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ROSES MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKRAKPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-675-0725
Mailing Address - Street 1:90 WASHINGTON ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1050
Mailing Address - Country:US
Mailing Address - Phone:973-675-0725
Mailing Address - Fax:973-675-0726
Practice Address - Street 1:90 WASHINGTON ST
Practice Address - Street 2:SUITE 307
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1050
Practice Address - Country:US
Practice Address - Phone:973-675-0725
Practice Address - Fax:973-675-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5002963332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006173Medicaid
NJ0006173Medicaid