Healthcare Provider Details

I. General information

NPI: 1346600749
Provider Name (Legal Business Name): STEPHEN ROSSMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ESSEX ST STE 203
HACKENSACK NJ
07601-8566
US

IV. Provider business mailing address

360 ESSEX ST STE 203
HACKENSACK NJ
07601-8566
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-8867
  • Fax: 551-996-8873
Mailing address:
  • Phone: 551-996-8867
  • Fax: 551-996-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number25MB09864300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: