Provider Demographics
NPI:1942498142
Name:ROSALIND EPSTEIN MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROSALIND EPSTEIN MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:G
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-881-6900
Mailing Address - Street 1:101 HOSPITAL LOOP NE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2129
Mailing Address - Country:US
Mailing Address - Phone:505-881-6900
Mailing Address - Fax:505-881-6111
Practice Address - Street 1:101 HOSPITAL LOOP NE
Practice Address - Street 2:SUITE 113
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2129
Practice Address - Country:US
Practice Address - Phone:505-881-6900
Practice Address - Fax:505-881-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-190207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17467Medicaid
NM17467Medicaid
NME30240Medicare UPIN