Provider Demographics
NPI:1710989140
Name:ROSEN, ALLEN EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:EDWIN
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17 SHELDRAKE LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6831
Mailing Address - Country:US
Mailing Address - Phone:561-659-1000
Mailing Address - Fax:561-659-1009
Practice Address - Street 1:5555 W BLUE HERON BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-7813
Practice Address - Country:US
Practice Address - Phone:561-659-1000
Practice Address - Fax:561-659-1009
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0032989207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067314500Medicaid
FL067314500Medicaid
FLE14699Medicare UPIN