Provider Demographics
NPI:1730278458
Name:ROSEN, MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:667 STONELEIGH AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2455
Mailing Address - Country:US
Mailing Address - Phone:845-278-5627
Mailing Address - Fax:845-314-1419
Practice Address - Street 1:667 STONELEIGH AVE STE 114
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2455
Practice Address - Country:US
Practice Address - Phone:845-278-5627
Practice Address - Fax:845-314-1419
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174280207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01721842Medicaid
NYE89277Medicare UPIN
NY86F711Medicare ID - Type Unspecified