Provider Demographics
NPI:1619909736
Name:ROSEN, CHAIM E (MD05)
Entity Type:Individual
Prefix:DR
First Name:CHAIM
Middle Name:E
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD05
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1439
Mailing Address - Country:US
Mailing Address - Phone:201-847-9403
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:SUITE 16
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1439
Practice Address - Country:US
Practice Address - Phone:201-847-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05463800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0732605Medicaid
609671Medicare ID - Type Unspecified
NJ0732605Medicaid