Healthcare Provider Details

I. General information

NPI: 1275965600
Provider Name (Legal Business Name): ROSEANN CERVELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W PROSPECT ST SUITE 2
EAST BRUNSWICK NJ
08816-2161
US

IV. Provider business mailing address

20 W LAKE CT
SOMERSET NJ
08873-4703
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-0600
  • Fax:
Mailing address:
  • Phone: 732-356-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37LC00096600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: