Healthcare Provider Details

I. General information

NPI: 1942444302
Provider Name (Legal Business Name): JOEL S. ROSEN, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 ROSCOE BLVD IFL 4TH FLOOR
NORTHRIDGE CA
91325-4105
US

IV. Provider business mailing address

18300 ROSCOE BLVD IFL 4TH FLOOR
NORTHRIDGE CA
91325-4105
US

V. Phone/Fax

Practice location:
  • Phone: 818-558-8342
  • Fax: 818-727-1451
Mailing address:
  • Phone: 818-885-5342
  • Fax: 818-727-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberG013193
License Number StateCA

VIII. Authorized Official

Name: SHIRLEY V JOHNSON
Title or Position: BILLER
Credential:
Phone: 818-885-5342