Provider Demographics
NPI:1588627509
Name:ROSEN, PAUL R (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:ROSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4041 HADLEY RD
Mailing Address - Street 2:SUITE R 101
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-1111
Mailing Address - Country:US
Mailing Address - Phone:908-757-0256
Mailing Address - Fax:908-757-0258
Practice Address - Street 1:4041 HADLEY RD
Practice Address - Street 2:SUITE R 101
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-1111
Practice Address - Country:US
Practice Address - Phone:908-757-0256
Practice Address - Fax:908-757-0258
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00047300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU26652Medicare UPIN
NJRO427927Medicare ID - Type Unspecified