Provider Demographics
NPI:1003865742
Name:ROSEN, HARVEY L (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:L
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3134
Mailing Address - Country:US
Mailing Address - Phone:908-228-2317
Mailing Address - Fax:908-228-2317
Practice Address - Street 1:246 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3134
Practice Address - Country:US
Practice Address - Phone:908-228-2317
Practice Address - Fax:908-228-2317
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197370207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01529840Medicaid
NY79J791Medicare ID - Type Unspecified
NY01529840Medicaid