Provider Demographics
NPI:1073616959
Name:ROSEN, RICHARD B (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 E 14TH ST
Mailing Address - Street 2:SUITE 319 SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4201
Mailing Address - Country:US
Mailing Address - Phone:212-979-4288
Mailing Address - Fax:212-979-4512
Practice Address - Street 1:310 E 14TH ST
Practice Address - Street 2:SUITE 319 SOUTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4288
Practice Address - Fax:212-979-4512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY173031207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD92198Medicare UPIN
NY15F941Medicare ID - Type Unspecified