Provider Demographics
NPI:1700331246
Name:ROJO, PHILIP MANUEL (MSN)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MANUEL
Last Name:ROJO
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SPRING ST
Mailing Address - Street 2:UNIT 805
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2276
Mailing Address - Country:US
Mailing Address - Phone:732-801-0683
Mailing Address - Fax:
Practice Address - Street 1:901 ROUTE 73 N
Practice Address - Street 2:SUITE C
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1226
Practice Address - Country:US
Practice Address - Phone:856-581-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00649800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health