Provider Demographics
NPI:1760207518
Name:PEREYRA, ROSA ANGELICA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:ANGELICA
Last Name:PEREYRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1427
Mailing Address - Country:US
Mailing Address - Phone:551-337-1618
Mailing Address - Fax:
Practice Address - Street 1:400 OLD HOOK RD STE 2-3
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2720
Practice Address - Country:US
Practice Address - Phone:201-781-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist