MEDICARE: AMY E ROSE MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207N00000X	Dermatology Physician	247173	NY

General Provider Information

NPI Number	:	1275724056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY E ROSE MD

Provider Business Mailing Address
First Line	:	401 E 74TH ST APT 5RS
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3919
Country	:	US
Telephone Number	:	917-414-1373
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 NORTHERN BLVD
Second Line	:
City	:	GREENVALE
State	:	NY
Zip	:	11548-1320
Country	:	US
Telephone Number	:	516-484-9000
Fax Number	:	516-484-7549

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	11/23/2021

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Directions to “ AMY E ROSE MD” Practice Location

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