Healthcare Provider Details

I. General information

NPI: 1366857997
Provider Name (Legal Business Name): ROSANNA EANG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 HARRISON AVE STE 1300
CAMDEN NJ
08105-3660
US

IV. Provider business mailing address

1865 HARRISON AVE STE 1300
CAMDEN NJ
08105-3660
US

V. Phone/Fax

Practice location:
  • Phone: 569-630-1268
  • Fax: 856-365-0279
Mailing address:
  • Phone: 569-630-1268
  • Fax: 856-365-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB09997100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: