Provider Demographics
NPI:1942444302
Name:JOEL S. ROSEN, MD, INC
Entity Type:Organization
Organization Name:JOEL S. ROSEN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-885-5342
Mailing Address - Street 1:18300 ROSCOE BLVD
Mailing Address - Street 2:IFL 4TH FLOOR
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4105
Mailing Address - Country:US
Mailing Address - Phone:818-885-5342
Mailing Address - Fax:818-727-1451
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:IFL 4TH FLOOR
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4105
Practice Address - Country:US
Practice Address - Phone:818-558-8342
Practice Address - Fax:818-727-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG013193273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508979469Medicare PIN