Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 213000062 | IL |
Y | 222Z00000X | Podiatrist | 213000062 | IL |
N | 224P00000X | Prosthetist |
NPI | 1043278138 |
---|---|
Provider Name | Sy H Rosen |
First Address | Evanston, IL 60203-1819 |
Second Address | Skokie, IL 60077-3703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
99322112 | BLUE CROSS (01) | IL |