Provider Demographics
NPI:1568423135
Name:ROSEN, CRAIG H (MD,)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:H
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 1:603 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1619
Mailing Address - Country:US
Mailing Address - Phone:856-848-3500
Mailing Address - Fax:858-848-1008
Practice Address - Street 1:603 N. BROAD ST.
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1619
Practice Address - Country:US
Practice Address - Phone:856-848-3500
Practice Address - Fax:858-848-1008
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA043710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC57864Medicare UPIN
NJ092966Medicare ID - Type UnspecifiedGROUP NUMBER