MEDICARE: ROSETTE DE REAL NP

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	207Q00000X	Family Medicine Physician	26NJ00738300	NJ
2	363LF0000X	Family Nurse Practitioner	341734	NY

General Provider Information

NPI Number	:	1528594173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSETTE DE REAL NP

Provider Business Mailing Address
First Line	:	15 AIMEE CT
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-2920
Country	:	US
Telephone Number	:	201-293-7659
Fax Number	:	308-832-4915

Provider Business Practice Location Address
First Line	:	15 AIMEE CT
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-2920
Country	:	US
Telephone Number	:	201-293-7659
Fax Number	:	308-832-4915

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	03/12/2026

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Directions to “ ROSETTE DE REAL NP” Practice Location

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