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ROSEVILLE MEDICAL GROUP PA NPI 1770893091


NPI Information

NPI: 1770893091
Provider Name: ROSEVILLE MEDICAL GROUP PA
Classification: Legal Medicine - 173000000X
Entity Type: Organization

CLIA Number: 31D2131565

Address:
346 ROSEVILLE AVE
NEWARK, NJ
ZIP 07107
Phone: (973) 482-7245
Get Directions

ROSEVILLE MEDICAL GROUP PA is a legal medicine in Newark, NJ. The provider is the specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. ROSEVILLE MEDICAL GROUP PA NPI is 1770893091. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

346 ROSEVILLE AVE
NEWARK, NJ
ZIP 07107-722
Phone: (973) 482-7245
Fax: (973) 482-0274

The provider's authorized official is Raouf Kamel Elias .
The authorized official title is Md and has the following contact phone number (973) 482-7245.

The CLIA number assigned to this NPI record is 31D2131565 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/20/2010 and was last updated on 4/11/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1173000000XLegal MedicineMA30602NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1452156MEDICARE UPINNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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