Provider Demographics
NPI:1811150246
Name:LA ROSA, NIURKA (MD)
Entity type:Individual
Prefix:DR
First Name:NIURKA
Middle Name:
Last Name:LA ROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIURKA
Other - Middle Name:
Other - Last Name:LA ROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6900 PARK AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4482
Mailing Address - Country:US
Mailing Address - Phone:201-779-4732
Mailing Address - Fax:
Practice Address - Street 1:6900 PARK AVE STE 3
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4483
Practice Address - Country:US
Practice Address - Phone:201-766-0086
Practice Address - Fax:201-766-0094
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08375200208000000X
NY249225208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY31809Medicaid
NJ0255700Medicaid