Provider Demographics
NPI:1265407514
Name:ROSEN, SCOTT FARRELL (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:FARRELL
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1731
Mailing Address - Country:US
Mailing Address - Phone:732-846-9500
Mailing Address - Fax:732-846-3931
Practice Address - Street 1:31 RIVER RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1731
Practice Address - Country:US
Practice Address - Phone:732-846-9500
Practice Address - Fax:732-846-3931
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07109100208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8935408Medicaid
055707Medicare ID - Type Unspecified
NJ8935408Medicaid