Provider Demographics
NPI:1730150632
Name:ROSEN, MICHAEL (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MILLBURN AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1943
Mailing Address - Country:US
Mailing Address - Phone:973-467-2500
Mailing Address - Fax:
Practice Address - Street 1:116 MILLBURN AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1943
Practice Address - Country:US
Practice Address - Phone:973-467-2500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03663400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0675504Medicaid
NJD96675Medicare UPIN
NJ0675504Medicaid