Provider Demographics
NPI:1164785176
Name:ROSEN, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 E 10TH ST
Mailing Address - Street 2:APT. 7C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:759 E 10TH ST
Practice Address - Street 2:APT. 7C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2347
Practice Address - Country:US
Practice Address - Phone:718-964-3230
Practice Address - Fax:718-859-4551
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist