Provider Demographics
NPI:1255510509
Name:ROSEN, RYAN (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1200 S FEDERAL HWY STE 302
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6058
Mailing Address - Country:US
Mailing Address - Phone:561-509-9382
Mailing Address - Fax:561-509-9362
Practice Address - Street 1:1200 S FEDERAL HWY STE 302
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6058
Practice Address - Country:US
Practice Address - Phone:561-509-9382
Practice Address - Fax:561-509-9362
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL159974208100000X
OH57013794208100000X
SC33459208100000X
GA75517208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC334597Medicaid
AA6927Medicare UPIN