Healthcare Provider Details

I. General information

NPI: 1437145059
Provider Name (Legal Business Name): JEFFREY HARRIS ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/09/2020
Certification Date: 02/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 AMBOY AVE
WOODBRIDGE NJ
07095-2960
US

IV. Provider business mailing address

453 AMBOY AVE
WOODBRIDGE NJ
07095-2960
US

V. Phone/Fax

Practice location:
  • Phone: 732-636-6612
  • Fax: 732-636-8224
Mailing address:
  • Phone: 732-636-6612
  • Fax: 732-636-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA046971
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: