Provider Demographics
NPI:1972897353
Name:MARTIN, ROSE ANNE (LMT)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:ANNE
Other - Last Name:GRISOLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2542
Mailing Address - Country:US
Mailing Address - Phone:201-666-7052
Mailing Address - Fax:
Practice Address - Street 1:37 BEECH ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2542
Practice Address - Country:US
Practice Address - Phone:201-666-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011203-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist