Provider Demographics
NPI:1699463083
Name:ROSARIO, MARTHA SHANELL
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:SHANELL
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 STATE ROUTE 57
Mailing Address - Street 2:
Mailing Address - City:PORT MURRAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07865-4029
Mailing Address - Country:US
Mailing Address - Phone:347-839-5076
Mailing Address - Fax:
Practice Address - Street 1:3251 3RD AVE STE 302B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6832
Practice Address - Country:US
Practice Address - Phone:718-708-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator