Provider Demographics
NPI:1386847986
Name:MICHAEL ERIC ROSEN, MD, PC
Entity Type:Organization
Organization Name:MICHAEL ERIC ROSEN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-489-8800
Mailing Address - Street 1:230 E 79TH ST APT 18F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1256
Mailing Address - Country:US
Mailing Address - Phone:212-988-2305
Mailing Address - Fax:212-977-9111
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1104
Practice Address - Country:US
Practice Address - Phone:212-489-8800
Practice Address - Fax:212-977-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-09
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02461989Medicaid
NY62S691Medicare ID - Type Unspecified
NYWWS361Medicare PIN
NY02461989Medicaid