Provider Demographics
NPI:1992849087
Name:ROSEN, TOVA (MD)
Entity Type:Individual
Prefix:MS
First Name:TOVA
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4711 12TH AVE APT C3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2527
Mailing Address - Country:US
Mailing Address - Phone:718-871-3820
Mailing Address - Fax:
Practice Address - Street 1:4711 12TH AVE APT A1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2526
Practice Address - Country:US
Practice Address - Phone:718-871-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179837208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87366Medicare UPIN
NY38F371Medicare ID - Type UnspecifiedMEDICARE AND BLUE CROSS