Roseville Medical Group PA
Legal Medicine in Newark, NJ. Organization (NPI-2).
NPI number1770893091
StatusActive
Last updated in NPPESApr 11, 2011
Details
- NPI
- 1770893091
- Entity type
- Organization (NPI-2)
- Legal business name
- Roseville Medical Group PA
- Organization subpart
- No
- Enumeration date
- Oct 20, 2010
- Last updated
- Apr 11, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 173000000X | Legal Medicine | ma30602 | NJ | Yes |
Practice location
346 Roseville AveNewark, NJ 07107-1722
Phone 973-482-7245 · Fax 973-482-0274
Mailing address
18 Alicia CtCedar Grove, NJ 07009-1901
Phone 973-857-1560
Authorized official
Raouf Kamel Elias
MD
9734827245
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