Provider Demographics
NPI:1225097454
Name:ROSE, MICHAEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:200 SCHULZ DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6745
Mailing Address - Country:US
Mailing Address - Phone:732-426-3420
Mailing Address - Fax:732-747-2606
Practice Address - Street 1:535 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-426-3420
Practice Address - Fax:732-747-2606
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201483-12086S0122X
NJ25MA073690002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
J24487OtherHEALTHNET
185240OtherAMERIGROUP
A584143OtherOXFORD
P00151046OtherRAILROAD MEDICARE
H64424Medicare UPIN
NJ059072QQXMedicare PIN