Provider Demographics
NPI:1437390382
Name:ROSEN, ERIC S (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8362 PINES BLVD # 296
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6600
Mailing Address - Country:US
Mailing Address - Phone:954-985-4066
Mailing Address - Fax:954-893-6818
Practice Address - Street 1:3702 WASHINGTON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8287
Practice Address - Country:US
Practice Address - Phone:954-967-6550
Practice Address - Fax:954-967-6553
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10680207RI0011X, 207RC0000X
NY253163207RC0000X
NJ25MB09076500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01341202Medicare PIN
FLHI266ZMedicare PIN