Provider Demographics
NPI:1972778785
Name:DAVIDSON, ROSARIO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROSARIO
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ROSARIO
Other - Middle Name:
Other - Last Name:CEDENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:310 W JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1832
Mailing Address - Country:US
Mailing Address - Phone:908-351-2222
Mailing Address - Fax:908-351-1977
Practice Address - Street 1:310 W JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1832
Practice Address - Country:US
Practice Address - Phone:908-351-2222
Practice Address - Fax:908-351-1977
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00084600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ183953RUQMedicare PIN