Provider Demographics
NPI:1740260322
Name:ROSEN, JAY (OD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SPENCER PL
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4111
Mailing Address - Country:US
Mailing Address - Phone:914-472-2020
Mailing Address - Fax:914-725-0793
Practice Address - Street 1:8 SPENCER PL
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4111
Practice Address - Country:US
Practice Address - Phone:914-472-2020
Practice Address - Fax:914-725-0793
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002798-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02219280001Medicare UPIN
NYC99921Medicare PIN