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NPI Code Detail

MEDICARE: DR. EDDIE ROSA MD

MEDICARE: DR. EDDIE ROSA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMA068804NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215045869
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDDIE ROSA MD
Provider Business Mailing Address
First Line : 796 MT PROSPECT AVE
Second Line :
City : NEWARK
State : NJ
Zip : 07104-3223
Country : US
Telephone Number : 973-350-1770
Fax Number : 973-350-1755
Provider Business Practice Location Address
First Line : 796 MT PROSPECT AVE
Second Line :
City : NEWARK
State : NJ
Zip : 07104-3223
Country : US
Telephone Number : 973-350-1770
Fax Number : 973-350-1755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/09/2007

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