Provider Demographics
NPI:1134136690
Name:ROSEN, FRANK MAYNARD (PSYD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:MAYNARD
Last Name:ROSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 UNIVERSITY PL
Mailing Address - Street 2:8C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4513
Mailing Address - Country:US
Mailing Address - Phone:212-774-9474
Mailing Address - Fax:
Practice Address - Street 1:88 UNIVERSITY PL
Practice Address - Street 2:8C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4513
Practice Address - Country:US
Practice Address - Phone:212-774-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02072228Medicaid
NYVL6311Medicare ID - Type Unspecified