Healthcare Provider Details

I. General information

NPI: 1790770253
Provider Name (Legal Business Name): ERIC ROSIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WILLARD AVE
BLOOMFIELD NJ
07003-4874
US

IV. Provider business mailing address

725 RIVER RD STE 32
EDGEWATER NJ
07020-1149
US

V. Phone/Fax

Practice location:
  • Phone: 973-289-6009
  • Fax:
Mailing address:
  • Phone: 201-951-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA07628800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07628800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00702489
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier0033413
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: