Healthcare Provider Details

I. General information

NPI: 1982568028
Provider Name (Legal Business Name): PINK ROSE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MAIN ST STE 105-106
MATAWAN NJ
07747-3186
US

IV. Provider business mailing address

844 HOLMDEL RD
HOLMDEL NJ
07733-1731
US

V. Phone/Fax

Practice location:
  • Phone: 732-858-0140
  • Fax: 732-889-2088
Mailing address:
  • Phone: 718-877-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELLE PERESIPA
Title or Position: OWNER
Credential: APN
Phone: 718-877-4085