Provider Demographics
NPI:1255333050
Name:ROSEN, LAWRENCE D (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:D
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1524
Mailing Address - Country:US
Mailing Address - Phone:201-634-1600
Mailing Address - Fax:201-634-1606
Practice Address - Street 1:690 KINDERKAMACK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1524
Practice Address - Country:US
Practice Address - Phone:201-634-1600
Practice Address - Fax:201-634-1606
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198034208000000X
NJ65632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01689454Medicaid
NY537461Medicare ID - Type Unspecified
NY01689454Medicaid