Provider Demographics
NPI:1629257209
Name:MARCIA ROSEN, PH.D.,PC
Entity Type:Organization
Organization Name:MARCIA ROSEN, PH.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-535-6657
Mailing Address - Street 1:24 E 82ND ST
Mailing Address - Street 2:APT. 5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0344
Mailing Address - Country:US
Mailing Address - Phone:212-535-6657
Mailing Address - Fax:212-988-7433
Practice Address - Street 1:24 E 82ND ST
Practice Address - Street 2:APT. 5B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0344
Practice Address - Country:US
Practice Address - Phone:212-535-6657
Practice Address - Fax:212-988-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004093-1261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56151Medicare PIN