Provider Demographics
NPI:1821084419
Name:ROSEN, JONATHAN MINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MINDER
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 HOSPITAL AVE
Mailing Address - Street 2:DANBURY HOSPITAL
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6099
Mailing Address - Country:US
Mailing Address - Phone:203-739-6341
Mailing Address - Fax:203-739-1585
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:DANBURY HOSPITAL
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-739-6341
Practice Address - Fax:203-739-1585
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165946-1207RC0200X, 207RP1001X
CT55549207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD02313Medicare UPIN
NY35183GMedicare ID - Type Unspecified
NY01018217Medicaid