Healthcare Provider Details

I. General information

NPI: 1184668121
Provider Name (Legal Business Name): KEVIN DAVID ROSIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 60TH ST SUITE 201
NEW YORK NY
10022-1008
US

IV. Provider business mailing address

30 E 60TH ST SUITE 201
NEW YORK NY
10022-1085
US

V. Phone/Fax

Practice location:
  • Phone: 212-355-5145
  • Fax: 212-308-3262
Mailing address:
  • Phone: 212-355-5145
  • Fax: 212-308-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV006632
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTUV006632
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTUV 006632
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTUV 006632
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV 006632
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: