Provider Demographics
NPI:1427060292
Name:ROSANIA, MARISA ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ELIZABETH
Last Name:ROSANIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LB# 7550 PO BOX 95000
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7550
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:91 S JEFFERSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1037
Practice Address - Country:US
Practice Address - Phone:973-538-6116
Practice Address - Fax:973-538-3712
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06010900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6987001Medicaid