Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | MB056943 | NJ |
NPI | 1275512840 |
---|---|
Provider Name | Dr. Robert Mark Rosen |
First Address | Toms River, NJ 08755-5059 |
Second Address | Toms River, NJ 08755-5059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 04/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C4433 | (02) | NJ |