Provider Demographics
NPI:1811938947
Name:ROSA, JOSE DOMINGO (DO)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DOMINGO
Last Name:ROSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4201
Mailing Address - Country:US
Mailing Address - Phone:203-576-5789
Mailing Address - Fax:
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:DEPT OF MEDICINE-MUNGER PAVILION
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1646
Practice Address - Country:US
Practice Address - Phone:914-493-8370
Practice Address - Fax:914-594-4434
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239121207R00000X, 207RC0200X
CT049160207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine