Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 188699 | NY |
Y | 208600000X | Surgeon | 188699 | NY |
N | 2082S0105X | Plastic Hand Surgeon | 188699 | NY |
NPI | 1710033584 |
---|---|
Provider Name | Mr. Kenneth M Rose SR. |
First Address | New York, NY 10023-6011 |
Second Address | New York, NY 10023-6011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 22/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01776865 | (05) | NY |
6015129 | GHI (01) | NY |
G49909 | (02) | NY |
N28073 | HEALTHNET (01) | NY |