=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467765479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSE K. NEWMAN P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2010
-----------------------------------------------------
Last Update Date | 07/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 154 S LIVINGSTON AVE SUITE 204
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-3017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-535-8616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 TILLOU RD W
-----------------------------------------------------
City | SOUTH ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07079-1357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-535-5644
-----------------------------------------------------
Fax | 973-535-5646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | QA05889
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------