Provider Demographics
NPI:1922082627
Name:ROSE, JOHN G (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 SHREWSBURY AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-741-5923
Mailing Address - Fax:732-741-2759
Practice Address - Street 1:595 SHREWSBURY AVE
Practice Address - Street 2:STE 103
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-741-5923
Practice Address - Fax:732-741-2759
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA028745208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1000467OtherGHI PPO
NJ0691208Medicaid
NJ293741OtherBCBS OF NY
NJ340012395OtherRAILROAD MEDICARE
NJ4393253OtherAETNA PPO
NJ0461625OtherAETNA HMO
NJ340012395OtherRAILROAD MEDICARE
NJD97086Medicare UPIN
NJ0461625OtherAETNA HMO