Healthcare Provider Details

I. General information

NPI: 1780330902
Provider Name (Legal Business Name): ROSEANN BENANTI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/25/2022
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 GRAND AVE STE 101
ENGLEWOOD NJ
07631-4141
US

IV. Provider business mailing address

81 PARKWAY
ROCHELLE PARK NJ
07662-4205
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-7044
  • Fax: 201-569-1999
Mailing address:
  • Phone: 201-805-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01241000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01241000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: