Provider Demographics
NPI:1619954229
Name:ROSEMARIN, JACK I (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:I
Last Name:ROSEMARIN
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 1:222 WESTCHESTER AVE
Mailing Address - Street 2:STE 308
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2906
Mailing Address - Country:US
Mailing Address - Phone:914-683-1555
Mailing Address - Fax:914-683-1026
Practice Address - Street 1:222 WESTCHESTER AVE
Practice Address - Street 2:STE 308
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2906
Practice Address - Country:US
Practice Address - Phone:914-683-1555
Practice Address - Fax:914-683-1026
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138599207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00762125Medicaid
NY90A461Medicare ID - Type Unspecified
NY00762125Medicaid