Provider Demographics
NPI:1942378443
Name:ROSEN, PAUL D SR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:ROSEN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 30129
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0129
Mailing Address - Country:US
Mailing Address - Phone:973-780-1122
Mailing Address - Fax:973-780-1081
Practice Address - Street 1:121 DEKALB AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8621
Practice Address - Fax:718-250-8878
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY207753146D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31554Medicare UPIN