Healthcare Provider Details

I. General information

NPI: 1730278458
Provider Name (Legal Business Name): MITCHELL ROSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE STE 114
CARMEL NY
10512-2455
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 114
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-5627
  • Fax: 845-314-1419
Mailing address:
  • Phone: 845-278-5627
  • Fax: 845-314-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number174280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: