Provider Demographics
NPI:1275678047
Name:ROSEN, MINDY CARA (RPAC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:CARA
Last Name:ROSEN
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 FLATBUSH AVE
Mailing Address - Street 2:ROOM BS 14
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4017
Mailing Address - Country:US
Mailing Address - Phone:718-564-2400
Mailing Address - Fax:
Practice Address - Street 1:911 FLATBUSH AVE
Practice Address - Street 2:ROOM BS 14
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4017
Practice Address - Country:US
Practice Address - Phone:718-564-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009632-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical