Healthcare Provider Details

I. General information

NPI: 1457562589
Provider Name (Legal Business Name): SIDNEY ROSEN M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E 82ND ST 1-B
NEW YORK NY
10028-0822
US

IV. Provider business mailing address

122 E 82ND ST 1-B
NEW YORK NY
10028-0822
US

V. Phone/Fax

Practice location:
  • Phone: 212-517-9272
  • Fax: 212-722-7594
Mailing address:
  • Phone: 212-517-9272
  • Fax: 212-722-7594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number072594
License Number StateNY

VIII. Authorized Official

Name: SIDNEY ROSEN
Title or Position: PRESIDENT
Credential: M.D .
Phone: 212-517-9272