Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | BR0933639 | NJ |
Y | 1223P0300X | Periodontist | DS026156-L | PA |
NPI | 1134553449 |
---|---|
Provider Name | Dr. Paul S. Rosen |
First Address | Yardley, PA 19067-5515 |
Second Address | Yardley, PA 19067-5515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2013 |
Last Update Date | 23/08/2013 |