Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 060895 | NY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN19525 | FL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 304925 | NY |
NPI | 1306122205 |
---|---|
Provider Name | Dr. Matthew Scott Rossen |
First Address | Tonawanda, NY 14150-4638 |
Second Address | Buffalo, NY 14209-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2011 |
Last Update Date | 24/04/2021 |