Provider Demographics
NPI:1801036595
Name:OSORIO, ROBIN (PA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:OSORIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:825 BLOOMFIELD AVE STE LL-1
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1366
Mailing Address - Country:US
Mailing Address - Phone:973-233-4493
Mailing Address - Fax:732-334-5059
Practice Address - Street 1:825 BLOOMFIELD AVE STE LL-1
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1366
Practice Address - Country:US
Practice Address - Phone:973-233-4493
Practice Address - Fax:732-334-5059
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMP000025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant