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NPI Code Detail

MEDICARE: ROXBARY LIPA

MEDICARE: ROXBARY LIPA
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
1363LF0000XFamily Nurse Practitioner26NJ15470300NJ

General Provider Information

NPI Number : 1740141423
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROXBARY LIPA
Provider Business Mailing Address
First Line : 821 PALMER ST
Second Line :
City : UNION
State : NJ
Zip : 07083-6758
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 178 MORRIS AVE
Second Line :
City : SPRINGFIELD
State : NJ
Zip : 07081-1217
Country : US
Telephone Number : 973-379-8771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2025
Last Update Date : 01/07/2026

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Directions to “ ROXBARY LIPA ” Practice Location

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