Provider Demographics
NPI:1083458079
Name:ROSARIO, RAFAEL A
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SOMERSET ST APT 303
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1874
Mailing Address - Country:US
Mailing Address - Phone:732-770-2733
Mailing Address - Fax:
Practice Address - Street 1:217 SOMERSET ST APT 303
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1874
Practice Address - Country:US
Practice Address - Phone:732-770-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No172A00000XOther Service ProvidersDriverGroup - Single Specialty