Healthcare Provider Details

I. General information

NPI: 1962366617
Provider Name (Legal Business Name): LA ROSA PEDIATRICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 PARK AVE APT 1
GUTTENBERG NJ
07093-4486
US

IV. Provider business mailing address

6905 PARK AVE APT 1
GUTTENBERG NJ
07093-4486
US

V. Phone/Fax

Practice location:
  • Phone: 201-766-0086
  • Fax: 949-437-3905
Mailing address:
  • Phone: 201-766-0086
  • Fax: 949-437-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: NIURKA LA ROSA
Title or Position: MD
Credential: MD
Phone: 201-779-4732