Healthcare Provider Details

I. General information

NPI: 1477414829
Provider Name (Legal Business Name): KIERRA ROSE OARE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FOREST AVE STE 100
PARAMUS NJ
07652-5238
US

IV. Provider business mailing address

10 FOREST AVE STE 100
PARAMUS NJ
07652-5238
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-1505
  • Fax: 201-996-1605
Mailing address:
  • Phone: 201-996-1505
  • Fax: 201-996-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00983500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: