Basic Information
| Provider Information | |||||||||
| NPI: | 1770769382 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSA OF SOUTHERN NEW JERSEY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 SEVEN SPRINGS WAY | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152501798 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1140 ROUTE 72 W | ||||||||
| Address2: | |||||||||
| City: | MANAHAWKIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080502412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099782194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2008 | ||||||||
| LastUpdateDate: | 01/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | MERRILL | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6152501798 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RADIATION ONCOLOGY SERVICES OF AMERICA, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.