Provider Demographics
NPI:1851779755
Name:FOSTER, ROYLETA (MED)
Entity Type:Individual
Prefix:
First Name:ROYLETA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 EVERGREEN PL STE 600
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2011
Mailing Address - Country:US
Mailing Address - Phone:862-253-6722
Mailing Address - Fax:
Practice Address - Street 1:134 EVERGREEN PL STE 600
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2011
Practice Address - Country:US
Practice Address - Phone:862-253-6722
Practice Address - Fax:877-308-0406
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No172V00000XOther Service ProvidersCommunity Health Worker
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities