Healthcare Provider Details

I. General information

NPI: 1811150246
Provider Name (Legal Business Name): NIURKA LA ROSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIURKA LA ROSA MD

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 PARK AVE STE 3
GUTTENBERG NJ
07093-4483
US

IV. Provider business mailing address

6900 PARK AVE SUITE 3
GUTTENBERG NJ
07093-4482
US

V. Phone/Fax

Practice location:
  • Phone: 201-766-0086
  • Fax: 201-766-0094
Mailing address:
  • Phone: 201-779-4732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08375200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number249225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: