Provider Demographics
NPI:1407810153
Name:ROSEN, ELENA (OD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-367-1147
Mailing Address - Fax:
Practice Address - Street 1:200 WEST 24TH STREET
Practice Address - Street 2:MAXIMEYES OPTICAL
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-929-3693
Practice Address - Fax:212-929-1620
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0056811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC22962Medicare PIN
U66073Medicare UPIN