Provider Demographics
NPI:1881022911
Name:ACCESS WT-LOSS CARE, LLC
Entity Type:Organization
Organization Name:ACCESS WT-LOSS CARE, LLC
Other - Org Name:ALL ACCESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:GASPAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:201-336-2725
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-0482
Mailing Address - Country:US
Mailing Address - Phone:201-336-2725
Mailing Address - Fax:732-358-7024
Practice Address - Street 1:291 HARDING AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-6457
Practice Address - Country:US
Practice Address - Phone:201-336-2725
Practice Address - Fax:732-358-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00162800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty