Provider Demographics
NPI:1679679757
Name:ROSEN, RICHARD ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ADAM
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:403 E 62ND ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7958
Mailing Address - Country:US
Mailing Address - Phone:917-599-6804
Mailing Address - Fax:212-734-8179
Practice Address - Street 1:20 E 68TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5844
Practice Address - Country:US
Practice Address - Phone:212-744-1333
Practice Address - Fax:212-734-8179
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02530963Medicaid