Provider Demographics
NPI:1407823404
Name:ROSEN, ARIE (MD)
Entity Type:Individual
Prefix:
First Name:ARIE
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1117
Mailing Address - Country:US
Mailing Address - Phone:201-996-9200
Mailing Address - Fax:201-996-9277
Practice Address - Street 1:2 S SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1117
Practice Address - Country:US
Practice Address - Phone:201-996-9200
Practice Address - Fax:201-996-9277
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06263000207Y00000X, 207YS0123X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
815672SGBMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
G19667Medicare UPIN