Healthcare Provider Details

I. General information

NPI: 1346205192
Provider Name (Legal Business Name): JOEL E ROSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33334-1687
US

IV. Provider business mailing address

100 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33334-1687
US

V. Phone/Fax

Practice location:
  • Phone: 964-351-0202
  • Fax:
Mailing address:
  • Phone: 954-351-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME182095
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD039346E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number298646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: