Provider Demographics
NPI:1033114202
Name:ROSE, MARION B (MD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:B
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:500 WEST MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-539-5400
Mailing Address - Fax:631-539-5401
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3027
Practice Address - Country:US
Practice Address - Phone:631-539-5400
Practice Address - Fax:631-539-5401
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2015-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1953212080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02372058Medicaid
NY040426011188OtherFIDELIS
NY25-01913OtherUNITEDHEALTHCARE CHILD HE
NY2136266OtherUNITED HEALTHCARE
NY2198784OtherGHI
NY5E6181OtherBLUE CROSS BLUE SHIELD
NY129244OtherVYTRA HEALTHCARE
NY3021002-003OtherCIGNA
NYP2734825OtherOXFORD HEALTH
NYAA71772OtherMDNY HEALTHCARE
NY2198784OtherGHI
NY02372058Medicaid