Provider Demographics
NPI:1497869663
Name:ROSE, LOUIS ALFRED (DO)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:ALFRED
Last Name:ROSE
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 1:3146 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5706
Mailing Address - Country:US
Mailing Address - Phone:718-409-6280
Mailing Address - Fax:718-409-4110
Practice Address - Street 1:3146 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5706
Practice Address - Country:US
Practice Address - Phone:718-409-6280
Practice Address - Fax:718-409-4110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC13828332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01488857Medicaid
NY0870060001Medicare NSC
NY0870060001Medicare ID - Type Unspecified