Provider Demographics
NPI:1942552328
Name:HENRIQUEZ-GONZALEZ, ROSANA SOFIA (MD)
Entity Type:Individual
Prefix:
First Name:ROSANA
Middle Name:SOFIA
Last Name:HENRIQUEZ-GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FRANKLIN ST APT 101D
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5439
Mailing Address - Country:US
Mailing Address - Phone:973-906-1585
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-5316
Practice Address - Fax:973-290-8329
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25499207R00000X
PAMD455637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine