Provider Demographics
NPI:1881724458
Name:ROSADO, MARTIN DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:DAVID
Last Name:ROSADO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:63 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2503
Mailing Address - Country:US
Mailing Address - Phone:845-267-8600
Mailing Address - Fax:
Practice Address - Street 1:41 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4204
Practice Address - Country:US
Practice Address - Phone:914-946-0520
Practice Address - Fax:914-946-0821
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist