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General NPI Number Information
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NPI Number | 1073904801
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Entity Type | Organization
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Legal Business Name | AVICENNA MEDICAL CENTER
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 129 VALLEY RD 2ND FLOOR
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2331
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Country | US
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Telephone | 973-746-2620
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Fax | 973-746-2579
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Provider Business Mailing Address
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Address Line | 129 VALLEY RD 2ND FLOOR
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2331
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Country | US
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Telephone | 973-746-2620
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Fax | 973-746-2579
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Authorized Official
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Title or Position | PRESIDENT/PSYCHIATRIST
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Name | DR. ANNA MICHELE ROSSI
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Credential | D.O.
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Telephone | 973-746-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 25MB07627000
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License Number State | NJ
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