Provider Demographics
NPI:1922080712
Name:ROOSA, DONNA C (CNM, MS)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:C
Last Name:ROOSA
Suffix:
Gender:F
Credentials:CNM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:25 LINDSLEY DRIVE
Practice Address - Street 2:SUITE 201 A
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4456
Practice Address - Country:US
Practice Address - Phone:973-998-7922
Practice Address - Fax:973-998-7925
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00017301367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4524004Medicaid
NJ4524004Medicaid