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General NPI Number Information
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NPI Number | 1164787636
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Entity Type | Organization
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Legal Business Name | PETER A. ROSA DDS, MD PC
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 1049 5TH AVE SUITE 1A
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City | NEW YORK
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State | NY
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Zip | 10028-0115
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Country | US
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Telephone | 212-861-1961
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Fax | 212-861-0561
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Provider Business Mailing Address
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Address Line | 1049 5TH AVE SUITE 1A
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City | NEW YORK
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State | NY
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Zip | 10028-0115
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Country | US
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Telephone | 212-861-1961
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Fax | 212-861-0561
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MATT DALLMANN
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Credential |
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Telephone | 212-206-6465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 252964
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License Number State | NY
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