Provider Demographics
NPI:1194267526
Name:ROSE, ERIN EILEEN (MS, ATC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:EILEEN
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:EILEEN
Other - Last Name:CARANNANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:131 MARTINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2709
Mailing Address - Country:US
Mailing Address - Phone:908-647-5555
Mailing Address - Fax:
Practice Address - Street 1:131 MARTINSVILLE RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2709
Practice Address - Country:US
Practice Address - Phone:908-647-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001593002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer