Healthcare Provider Details

I. General information

NPI: 1972546430
Provider Name (Legal Business Name): RITCHARD ROSEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 ENGLE ST
ENGLEWOOD NJ
07631-2507
US

IV. Provider business mailing address

142 ENGLE ST
ENGLEWOOD NJ
07631-2507
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-0033
  • Fax: 201-568-3453
Mailing address:
  • Phone: 201-568-0033
  • Fax: 201-568-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD01562
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: