Provider Demographics
NPI:1790372852
Name:COFRANCESCO, ROSEMARIE ANNE
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:ANNE
Last Name:COFRANCESCO
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 1:22 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07439-1203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 WATER ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1415
Practice Address - Country:US
Practice Address - Phone:973-383-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02850400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
111402290816OtherOTHER
111402290816OtherSELF