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General NPI Number Information
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NPI Number | 1518152453
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Entity Type | Organization
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Legal Business Name | MARCY ROSHELLI
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 1301 ROUTE 72 W SUITE 250
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2483
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Country | US
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Telephone | 609-312-9269
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Fax | 609-207-4102
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Provider Business Mailing Address
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Address Line | 18 N 7TH ST
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City | SURF CITY
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State | NJ
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Zip | 08008-5201
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Country | US
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Telephone | 609-312-9269
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Fax | 609-207-4102
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Authorized Official
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Title or Position | OWNER
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Name | MARCELLA ROSHELLI
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Credential | APRN-BC
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Telephone | 609-312-9269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NN05675900
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License Number State | NJ
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