Provider Demographics
NPI:1710317003
Name:ROSEN, GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 EAST 54TH ST.
Mailing Address - Street 2:
Mailing Address - City:N.Y
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-753-9860
Mailing Address - Fax:212-753-9879
Practice Address - Street 1:59 EAST 54TH ST.
Practice Address - Street 2:
Practice Address - City:N.Y
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-753-9860
Practice Address - Fax:212-753-9860
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0216051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice