Provider Demographics
NPI:1962451989
Name:ROSEN, MATTHEW (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 ROUTE 45
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1116
Mailing Address - Country:US
Mailing Address - Phone:845-213-8761
Mailing Address - Fax:845-459-6230
Practice Address - Street 1:873 ROUTE 45
Practice Address - Street 2:SUITE 204A
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1116
Practice Address - Country:US
Practice Address - Phone:845-213-8761
Practice Address - Fax:845-459-6230
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00954018Medicaid
NYDD1826Medicare ID - Type Unspecified
NY00954018Medicaid