Provider Demographics
NPI:1932333911
Name:EVAN G ROSEN M D P A
Entity Type:Organization
Organization Name:EVAN G ROSEN M D P A
Other - Org Name:LIGHTHOUSE UROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-743-5580
Mailing Address - Street 1:2141 S ALTERNATE A1A
Mailing Address - Street 2:SUITE 420
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4072
Mailing Address - Country:US
Mailing Address - Phone:561-743-5580
Mailing Address - Fax:561-743-5595
Practice Address - Street 1:2141 S ALTERNATE A1A
Practice Address - Street 2:SUITE 420
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4072
Practice Address - Country:US
Practice Address - Phone:561-743-5580
Practice Address - Fax:561-743-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty