Provider Demographics
NPI:1760455364
Name:ROSALES, ROWENA G (MD)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:G
Last Name:ROSALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2454
Mailing Address - Street 2:BIMC FACULTY PRACTICE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2454
Mailing Address - Country:US
Mailing Address - Phone:212-252-6174
Mailing Address - Fax:
Practice Address - Street 1:55 E 34TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4337
Practice Address - Country:US
Practice Address - Phone:212-252-6171
Practice Address - Fax:212-696-2406
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01850040Medicaid
NY20N161Medicare ID - Type Unspecified
NY01850040Medicaid