MEDICARE: DR. ROSE OOSTING PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2149	NJ
2	103TC0700X	Clinical Psychologist	2149	NJ

General Provider Information

NPI Number	:	1285630616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSE OOSTING PHD

Provider Business Mailing Address
First Line	:	5 DURYEA RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1901
Country	:	US
Telephone Number	:	973-746-8603
Fax Number	:	973-746-8603

Provider Business Practice Location Address
First Line	:	5 DURYEA RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1901
Country	:	US
Telephone Number	:	973-746-8603
Fax Number	:	973-746-8603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	09/11/2025

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