Provider Demographics
NPI:1811944549
Name:ROSEN, LUBA P (MD)
Entity type:Individual
Prefix:
First Name:LUBA
Middle Name:P
Last Name:ROSEN
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 1:118 PINE GROVE ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1766
Mailing Address - Country:US
Mailing Address - Phone:617-734-6135
Mailing Address - Fax:
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:#102
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4500
Practice Address - Country:US
Practice Address - Phone:617-734-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151234208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3181146Medicaid
MA3181146Medicaid