MEDICARE: ROSETTA BROWN 653-10623PH1

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	246RP1900X	Phlebotomy Technician	653-10623	NJ

General Provider Information

NPI Number	:	1538039037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSETTA BROWN 653-10623PH1

Provider Business Mailing Address
First Line	:	100 MAPLEWOOD DR APT B
Second Line	:
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-1970
Country	:	US
Telephone Number	:	609-712-3926
Fax Number	:	609-712-3926

Provider Business Practice Location Address
First Line	:	1209 ROUTE 70 W
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-3532
Country	:	US
Telephone Number	:	856-320-8553
Fax Number	:	856-320-8553

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

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/10/2025

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