| Roosanna Modesto Md Pa | |
|
773 Teaneck Rd Teaneck NJ 07666-4846 | |
| (201) 837-7662 | |
| Not Available |
| Full Name | Roosanna Modesto Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 773 Teaneck Rd, Teaneck, New Jersey |
| Authorized Official Name and Position | Rosanna Modesto (OWNER) |
| Authorized Official Contact | 2018377662 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roosanna Modesto Md Pa 773 Teaneck Rd Teaneck NJ 07666-4846 Ph: (201) 837-7662 | Roosanna Modesto Md Pa 773 Teaneck Rd Teaneck NJ 07666-4846 Ph: (201) 837-7662 |
| NPI Number | 1427494954 |
|---|---|
| Provider Enumeration Date | 05/10/2013 |
| Last Update Date | 05/10/2013 |
| Medicare PECOS PAC ID | 4082843446 |
|---|---|
| Medicare Enrollment ID | O20140204001923 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427494954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Rosanna A Modesto |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306856778 PECOS PAC ID: 4587609474 Enrollment ID: I20050622000013 |
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