Provider Demographics
NPI:1992983522
Name:ROSEDALE MEDICAL PC
Entity type:Organization
Organization Name:ROSEDALE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SYED-NAQVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-634-4300
Mailing Address - Street 1:415 AVENEL ST
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1147
Mailing Address - Country:US
Mailing Address - Phone:732-636-7888
Mailing Address - Fax:732-636-7887
Practice Address - Street 1:415 AVENEL ST
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1147
Practice Address - Country:US
Practice Address - Phone:732-636-7888
Practice Address - Fax:732-636-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07505700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0150452Medicaid
NJ0150452Medicaid