Healthcare Provider Details

I. General information

NPI: 1407773245
Provider Name (Legal Business Name): YEHUDA ROSEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 DUQUESNE BLVD STE 2
BRICK NJ
08723-5073
US

IV. Provider business mailing address

14733 70TH AVE
FLUSHING NY
11367-1715
US

V. Phone/Fax

Practice location:
  • Phone: 201-566-3965
  • Fax:
Mailing address:
  • Phone: 201-566-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number263-003
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: