Basic Information
| Provider Information | |||||||||
| NPI: | 1255404935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSICA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 BALMORAL LN | ||||||||
| Address2: | |||||||||
| City: | SCOTCH PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070762203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087551823 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 POCONO RD | ||||||||
| Address2: | DENVILLE HOSPITAL | ||||||||
| City: | DENVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078342954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736256000 | ||||||||
| FaxNumber: | 9739832293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 25MA03934100 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5445001 | 05 | NJ | MEDICAID |