Healthcare Provider Details

I. General information

NPI: 1669583621
Provider Name (Legal Business Name): CLARE ROVITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ELM ST
HARRINGTON PARK NJ
07640-1902
US

IV. Provider business mailing address

24 ELM ST
HARRINGTON PARK NJ
07640-1902
US

V. Phone/Fax

Practice location:
  • Phone: 201-784-0123
  • Fax: 201-784-0065
Mailing address:
  • Phone: 201-784-0123
  • Fax: 201-784-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00112800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: