Provider Demographics
NPI:1447027701
Name:JEREMIAH, ROSE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARIE
Last Name:JEREMIAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:MARIE
Other - Last Name:MALCOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:159 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3201
Mailing Address - Country:US
Mailing Address - Phone:973-876-6781
Mailing Address - Fax:
Practice Address - Street 1:22-18 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3016
Practice Address - Country:US
Practice Address - Phone:201-475-5050
Practice Address - Fax:201-475-5522
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01194300363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care