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General NPI Number Information
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NPI Number | 1770893091
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Entity Type | Organization
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Legal Business Name | ROSEVILLE MEDICAL GROUP PA
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 346 ROSEVILLE AVE
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City | NEWARK
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State | NJ
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Zip | 07107-1722
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Country | US
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Telephone | 973-482-7245
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Fax | 973-482-0274
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Provider Business Mailing Address
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Address Line | 18 ALICIA CT
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City | CEDAR GROVE
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State | NJ
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Zip | 07009-1901
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Country | US
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Telephone | 973-857-1560
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. RAOUF KAMEL ELIAS
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Credential |
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Telephone | 973-482-7245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MA30602
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License Number State | NJ
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