MEDICARE: MARION B ROSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	195321	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	040426011188	OTHER	NY	FIDELIS
3	25-01913	OTHER	NY	UNITEDHEALTHCARE CHILD HE
4	2136266	OTHER	NY	UNITED HEALTHCARE
5	2198784	OTHER	NY	GHI
6	5E6181	OTHER	NY	BLUE CROSS BLUE SHIELD
7	129244	OTHER	NY	VYTRA HEALTHCARE
8	3021002-003	OTHER	NY	CIGNA
9	P2734825	OTHER	NY	OXFORD HEALTH
10	AA71772	OTHER	NY	MDNY HEALTHCARE

General Provider Information

NPI Number	:	1033114202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARION B ROSE M.D.

Provider Business Mailing Address
First Line	:	500 WEST MAIN STREET
Second Line	:	SUITE 204
City	:	BABYLON
State	:	NY
Zip	:	11702
Country	:	US
Telephone Number	:	631-539-5400
Fax Number	:	631-539-5401

Provider Business Practice Location Address
First Line	:	500 W MAIN ST
Second Line	:	SUITE 204
City	:	BABYLON
State	:	NY
Zip	:	11702-3027
Country	:	US
Telephone Number	:	631-539-5400
Fax Number	:	631-539-5401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/30/2015

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Directions to “ MARION B ROSE M.D.” Practice Location

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