Healthcare Provider Details

I. General information

NPI: 1053188169
Provider Name (Legal Business Name): ROSIE TESLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MADISON AVE
LAKEWOOD NJ
08701-3225
US

IV. Provider business mailing address

7 HEKEL RD
LAKEWOOD NJ
08701-5263
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-7770
  • Fax:
Mailing address:
  • Phone: 347-309-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14970500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: