Healthcare Provider Details

I. General information

NPI: 1265342760
Provider Name (Legal Business Name): ELISE ROSE ROSATI CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MAUREEN CT
MARLTON NJ
08053-1405
US

IV. Provider business mailing address

114 MAUREEN CT
MARLTON NJ
08053-1405
US

V. Phone/Fax

Practice location:
  • Phone: 856-506-1056
  • Fax:
Mailing address:
  • Phone: 856-506-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number88296
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: