Provider Demographics
NPI:1770609505
Name:ROSEN, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:MOUNT KISCO MEDICAL GROUP PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-666-3109
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-666-3109
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY222829207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02593300Medicaid
NYI02684Medicare UPIN
NY0014S06761Medicare PIN