Provider Demographics
NPI:1457388498
Name:ROSE, T (MD)
Entity Type:Individual
Prefix:DR
First Name:T
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GREEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9070
Mailing Address - Country:US
Mailing Address - Phone:732-740-1602
Mailing Address - Fax:
Practice Address - Street 1:21 GREEN SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-9070
Practice Address - Country:US
Practice Address - Phone:732-740-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186041207R00000X
NJ25MA05615100207RH0000X
NJMA605615100207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0044962Medicaid
NJF84113Medicare UPIN
NJ083735Medicare ID - Type Unspecified