Provider Demographics
NPI:1811751449
Name:ROSEN, SHULAMITH (PA)
Entity type:Individual
Prefix:
First Name:SHULAMITH
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 TENNYSON PL
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4514
Mailing Address - Country:US
Mailing Address - Phone:973-767-3645
Mailing Address - Fax:
Practice Address - Street 1:52 TENNYSON PL
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4514
Practice Address - Country:US
Practice Address - Phone:973-767-3645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00834700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant