Provider Demographics
NPI:1780330902
Name:BENANTI, ROSEANN (NP-C)
Entity type:Individual
Prefix:
First Name:ROSEANN
Middle Name:
Last Name:BENANTI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4205
Mailing Address - Country:US
Mailing Address - Phone:201-805-8636
Mailing Address - Fax:
Practice Address - Street 1:420 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4141
Practice Address - Country:US
Practice Address - Phone:201-569-7044
Practice Address - Fax:201-569-1999
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01241000363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology