Healthcare Provider Details

I. General information

NPI: 1386677680
Provider Name (Legal Business Name): HAZEL D ROVNO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAZEL DIANE SARAH ROVNO M.D.

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 INDIAN RUN
TRENTON NJ
08648-1082
US

IV. Provider business mailing address

5 INDIAN RUN
LAWRENCEVILLE NJ
08648-1082
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax: 612-294-4903
Mailing address:
  • Phone: 908-229-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD062685L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA05931600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: