Provider Demographics
NPI:1215390307
Name:ROSEN, RAPHAEL JUDAH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:JUDAH
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:292 LONG RIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1627
Mailing Address - Country:US
Mailing Address - Phone:203-324-7666
Mailing Address - Fax:203-323-2541
Practice Address - Street 1:292 LONG RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1627
Practice Address - Country:US
Practice Address - Phone:203-324-7666
Practice Address - Fax:203-323-2541
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT70833207RN0300X
NY291865208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology