Provider Demographics
NPI:1790703858
Name:ROSENTHAL, JUDITH TRAINER (FNP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:TRAINER
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1219
Mailing Address - Country:US
Mailing Address - Phone:201-767-3164
Mailing Address - Fax:
Practice Address - Street 1:880 RIVER RD
Practice Address - Street 2:MINUTECLINIC/CVS
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-3016
Practice Address - Country:US
Practice Address - Phone:612-659-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN36599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMR1133797OtherDEA
NYMR1133797OtherDEA