Provider Demographics
NPI:1356524938
Name:BARRY J ROSEN DPM
Entity type:Organization
Organization Name:BARRY J ROSEN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-225-2424
Mailing Address - Street 1:5847 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1698
Mailing Address - Country:US
Mailing Address - Phone:718-225-2424
Mailing Address - Fax:718-225-2425
Practice Address - Street 1:5847 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1698
Practice Address - Country:US
Practice Address - Phone:718-225-2424
Practice Address - Fax:718-225-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003625213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0250690001Medicare NSC