Healthcare Provider Details

I. General information

NPI: 1568508067
Provider Name (Legal Business Name): JOEL ELLIOT ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MAIN ST #1
NORTHAMPTON MA
01060-3137
US

IV. Provider business mailing address

77 WARNER ST
FLORENCE MA
01062-2735
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-3191
  • Fax:
Mailing address:
  • Phone: 413-584-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number57413
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: