Provider Demographics
NPI:1851953251
Name:ROSIAK, THERESA MARY
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARY
Last Name:ROSIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:ROSIAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:357 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-2122
Mailing Address - Country:US
Mailing Address - Phone:609-413-5398
Mailing Address - Fax:
Practice Address - Street 1:357 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2122
Practice Address - Country:US
Practice Address - Phone:609-413-5398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
No1744G0900XOther Service ProvidersSpecialistGraphics Designer