Healthcare Provider Details

I. General information

NPI: 1659734572
Provider Name (Legal Business Name): DANIEL C ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 1900S
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE STE 1900S
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-347-1900
  • Fax:
Mailing address:
  • Phone: 914-347-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0090593
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number314037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: