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General NPI Number Information
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NPI Number | 1295526242
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Entity Type | Individual
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Provider Name | JANIS DESROSIERS
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Gender |
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1418 NEW RD STE 1C
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1179
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Country | US
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Telephone | 609-699-5750
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Fax |
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Provider Business Mailing Address
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Address Line | 2106 NEW RD STE F1
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City | LINWOOD
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State | NJ
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Zip | 08221-1053
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Country | US
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Telephone | 609-699-5750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NR15611100
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License Number State | NJ
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