Provider Demographics
NPI:1629119565
Name:ROSEN, ELAINE R (PT, DHSC)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:R
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PT, DHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 190TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1855
Mailing Address - Country:US
Mailing Address - Phone:718-217-4083
Mailing Address - Fax:
Practice Address - Street 1:6940 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3851
Practice Address - Country:US
Practice Address - Phone:718-544-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03728GMedicare ID - Type UnspecifiedPROVIDER NUMBER