Provider Demographics
NPI:1699808568
Name:GERALD ROSEN MD INC
Entity Type:Organization
Organization Name:GERALD ROSEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-285-0044
Mailing Address - Street 1:25 ANN ST
Mailing Address - Street 2:APT. #10
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2404
Mailing Address - Country:US
Mailing Address - Phone:212-284-0044
Mailing Address - Fax:212-604-6024
Practice Address - Street 1:25 ANN ST
Practice Address - Street 2:APT. #10
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2404
Practice Address - Country:US
Practice Address - Phone:212-284-0044
Practice Address - Fax:212-604-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA90592Medicare UPIN
NY658682Medicare ID - Type Unspecified