Provider Demographics
NPI:1528279544
Name:WILLIAMS, ROSA G (PA-C)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:75 MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-1635
Mailing Address - Country:US
Mailing Address - Phone:973-472-4777
Mailing Address - Fax:973-972-8553
Practice Address - Street 1:90 BERGEN STREET
Practice Address - Street 2:STE 8100
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-2323
Practice Address - Fax:973-972-8553
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00014000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0639333636Medicaid