Provider Demographics
NPI:1982219572
Name:ROSADO, SONIA M (LMT)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:M
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 MOORE ST # BE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4045
Mailing Address - Country:US
Mailing Address - Phone:201-449-7763
Mailing Address - Fax:
Practice Address - Street 1:270 MOORE ST # BE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4045
Practice Address - Country:US
Practice Address - Phone:201-449-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00538200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist