Healthcare Provider Details

I. General information

NPI: 1417222126
Provider Name (Legal Business Name): W R ROSEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NE 26TH AVE SUITE 206
POMPANO BEACH FL
33062-5239
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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPO00039
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JANET WOODALL
Title or Position: DIRECTOR, CONTRACTING
Credential:
Phone: 336-397-0993