Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 664 | MA |
NPI | 1003905274 |
---|---|
Provider Name | Dr. Martin G. Rosen |
First Address | Wellesley, MA 02482-5935 |
Second Address | Wellesley, MA 02482-5935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 29/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1612875 | (05) | MA |
Y35460 | BLUE CROSS BLUE SHIELD (01) | MA |