Healthcare Provider Details

I. General information

NPI: 1336671460
Provider Name (Legal Business Name): W R ROSEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SE 15TH AVE
FORT LAUDERDALE FL
33301-3985
US

IV. Provider business mailing address

2534 EMPIRE DR
WINSTON SALEM NC
27103-6710
US

V. Phone/Fax

Practice location:
  • Phone: 954-447-7779
  • Fax: 954-447-7782
Mailing address:
  • Phone: 336-397-2165
  • Fax: 336-397-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name: JODY MITCHELL
Title or Position: DIRECTOR, REIMBURSEMENT
Credential:
Phone: 336-397-2616