Provider Demographics
NPI:1275515231
Name:ROSENSON, VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:ROSENSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3401
Mailing Address - Country:US
Mailing Address - Phone:917-282-1604
Mailing Address - Fax:
Practice Address - Street 1:625 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-3401
Practice Address - Country:US
Practice Address - Phone:973-423-4841
Practice Address - Fax:973-423-4841
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022754001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ205814976OtherTAX ID