Healthcare Provider Details

I. General information

NPI: 1942104153
Provider Name (Legal Business Name): ANA KAREN ROSARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 KIPP AVE
LODI NJ
07644-2946
US

IV. Provider business mailing address

79 KIPP AVE
LODI NJ
07644-2946
US

V. Phone/Fax

Practice location:
  • Phone: 917-536-5707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15671700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: