Provider Demographics
NPI:1518532365
Name:ZACHARY B. ROSE, PSY.D., PLLC
Entity Type:Organization
Organization Name:ZACHARY B. ROSE, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-234-5005
Mailing Address - Street 1:132 HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-4003
Mailing Address - Country:US
Mailing Address - Phone:516-234-5005
Mailing Address - Fax:
Practice Address - Street 1:132 HARBOR LN
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-4003
Practice Address - Country:US
Practice Address - Phone:516-234-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health