Provider Demographics
NPI:1881768042
Name:ROSIN, ERIC S (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:ROSIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W. ASHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1310
Mailing Address - Country:US
Mailing Address - Phone:610-461-6450
Mailing Address - Fax:610-461-1842
Practice Address - Street 1:901 W. ASHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1310
Practice Address - Country:US
Practice Address - Phone:610-461-6450
Practice Address - Fax:610-461-1842
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008610L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001505116Medicaid
PAF85928Medicare UPIN
PA162129YDMTMedicare PIN