Provider Demographics
NPI:1851431936
Name:BENJAMIN I ROSIN, MD PC
Entity Type:Organization
Organization Name:BENJAMIN I ROSIN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:ROSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-765-4499
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:SUITE 103-611
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:602-765-4499
Mailing Address - Fax:602-765-0405
Practice Address - Street 1:4921 E BELL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:602-765-4499
Practice Address - Fax:602-765-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ103502Medicare PIN