Healthcare Provider Details

I. General information

NPI: 1740141423
Provider Name (Legal Business Name): ROXBARY LIPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 MORRIS AVE
SPRINGFIELD NJ
07081-1217
US

IV. Provider business mailing address

821 PALMER ST
UNION NJ
07083-6758
US

V. Phone/Fax

Practice location:
  • Phone: 973-379-8771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15470300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: