MEDICARE: MRS. DONNA C. ROOSA CNM, MS

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	367A00000X	Advanced Practice Midwife	25ME00017301	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1922080712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA C. ROOSA CNM, MS

Provider Business Mailing Address
First Line	:	PO BOX 22581
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-2581
Country	:	US
Telephone Number	:	856-669-6050
Fax Number	:	856-528-3117

Provider Business Practice Location Address
First Line	:	25 LINDSLEY DRIVE
Second Line	:	SUITE 201 A
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-4456
Country	:	US
Telephone Number	:	973-998-7922
Fax Number	:	973-998-7925

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/19/2021

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