Provider Demographics
NPI:1346495207
Name:ROSA, DOMINIK
Entity Type:Individual
Prefix:
First Name:DOMINIK
Middle Name:
Last Name:ROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT OF ANESTHESIOLOGY
Mailing Address - Street 2:333 CEDAR STREET TMP 3
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515
Mailing Address - Country:US
Mailing Address - Phone:203-785-2802
Mailing Address - Fax:203-785-6664
Practice Address - Street 1:YALE-NEW HAVEN HOSPITAL
Practice Address - Street 2:20 YORK STREET
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3202
Practice Address - Country:US
Practice Address - Phone:203-785-2802
Practice Address - Fax:203-785-6664
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250950207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology