Healthcare Provider Details

I. General information

NPI: 1568318038
Provider Name (Legal Business Name): LUIS GUILLERMO ABREU ROSARIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 STATE ST APT 2A
HACKENSACK NJ
07601-5439
US

IV. Provider business mailing address

136 STATE ST APT 2A
HACKENSACK NJ
07601-5439
US

V. Phone/Fax

Practice location:
  • Phone: 347-485-4918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number360661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: