MEDICARE: MRS. AMY ROSE CUSACK FNP-C

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
1	363LF0000X	Family Nurse Practitioner	26NJ01041000	NJ

General Provider Information

NPI Number	:	1336767359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY ROSE CUSACK FNP-C

Provider Business Mailing Address
First Line	:	3201 BRIDGE AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3468
Country	:	US
Telephone Number	:	732-444-1103
Fax Number	:	848-241-3167

Provider Business Practice Location Address
First Line	:	3201 BRIDGE AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3468
Country	:	US
Telephone Number	:	732-444-1103
Fax Number	:	848-241-3167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	04/24/2026

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