Healthcare Provider Details

I. General information

NPI: 1205517497
Provider Name (Legal Business Name): MICHELLE DEL ROSARIO AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 2ND ST
HACKENSACK NJ
07601-2191
US

IV. Provider business mailing address

11-09 FAIRHAVEN PL
FAIR LAWN NJ
07410-1661
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15509300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: