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General NPI Number Information
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NPI Number | 1366687642
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Entity Type | Organization
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Legal Business Name | JNR SPORTS MEDICINE PC
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 1095 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10128-1154
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Country | US
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Telephone | 212-427-7750
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Fax | 212-427-7759
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Provider Business Mailing Address
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Address Line | 1095 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10128-1154
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Country | US
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Telephone | 212-427-7750
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Fax | 212-427-7759
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DONALD ROSE
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Credential | M.D.
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Telephone | 212-427-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 147983
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License Number State | NY
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