Healthcare Provider Details

I. General information

NPI: 1962416461
Provider Name (Legal Business Name): DENNIS J ROSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 COLUMBIA DRIVE
AMHERST MA
01002
US

IV. Provider business mailing address

157 COLUMBIA DRIVE
AMHERST MA
01002
US

V. Phone/Fax

Practice location:
  • Phone: 413-259-1777
  • Fax: 413-253-1507
Mailing address:
  • Phone: 413-259-1777
  • Fax: 413-253-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number34822
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: