Provider Demographics
NPI:1568508067
Name:ROSEN, JOEL ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ELLIOT
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 1:77 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-2735
Mailing Address - Country:US
Mailing Address - Phone:413-584-0588
Mailing Address - Fax:
Practice Address - Street 1:160 MAIN ST
Practice Address - Street 2:#1
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3137
Practice Address - Country:US
Practice Address - Phone:413-586-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57413204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30237OtherBLUE CROSS BLUE SHIELD
MA19800OtherHEALTH NEW ENGLAND
MAJ30237OtherBLUE CROSS BLUE SHIELD