Healthcare Provider Details

I. General information

NPI: 1992849087
Provider Name (Legal Business Name): TOVA ROSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA ROSEN M.D.

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/08/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 12TH AVE APT A1
BROOKLYN NY
11219-2526
US

IV. Provider business mailing address

4711 12TH AVE APT C3
BROOKLYN NY
11219-2527
US

V. Phone/Fax

Practice location:
  • Phone: 718-871-3820
  • Fax:
Mailing address:
  • Phone: 718-871-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number179837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: