Provider Demographics
NPI:1649290859
Name:HOWARD J ROSEN MD INC.
Entity type:Organization
Organization Name:HOWARD J ROSEN MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-373-7246
Mailing Address - Street 1:21A MANDEVILLE CT
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5745
Mailing Address - Country:US
Mailing Address - Phone:831-373-7246
Mailing Address - Fax:831-373-6187
Practice Address - Street 1:21A MANDEVILLE CT
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5745
Practice Address - Country:US
Practice Address - Phone:831-373-7246
Practice Address - Fax:831-373-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43873208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05376ZOtherBLUE SHIELD GROUP
CAZZZ24965ZMedicare ID - Type UnspecifiedGROUP
CAZZZ05376ZOtherBLUE SHIELD GROUP