Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11064 | MA |
NPI | 1053329821 |
---|---|
Provider Name | Dr. Jan Barry Rozen |
First Address | Lynnfield, MA 01940 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |