Provider Demographics
NPI:1669523783
Name:ROSEN, ALAN J (DPM)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 E 87TH ST
Mailing Address - Street 2:SUITE407
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2226
Mailing Address - Country:US
Mailing Address - Phone:212-861-2997
Mailing Address - Fax:212-861-3749
Practice Address - Street 1:177 E 87TH ST
Practice Address - Street 2:SUITE407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2226
Practice Address - Country:US
Practice Address - Phone:212-861-2997
Practice Address - Fax:212-861-3749
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004590213E00000X, 213EP1101X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P50842OtherBCBS
480029371OtherRAILROAD
P50841OtherBCBS
NY01179506Medicaid
KS4442997OtherOXFORD
P50841OtherBCBS
P50842Medicare PIN
NYT93371Medicare UPIN