Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 198804 | NY |
NPI | 1245226414 |
---|---|
Provider Name | Jeffrey Rosen |
First Address | Flushing, NY 11355-5045 |
Second Address | Flushing, NY 11355-5045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00669 | MEDICARE GRP (01) | NY |
01953539 | (05) | NY |
A400011399 | MEDICARE PTAN (01) | NY |
G400000332 | MEDICARE PTAN (01) | NY |
G71865 | (02) | NY |