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General NPI Number Information
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NPI Number | 1407175078
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Entity Type | Individual
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Provider Name | EVAN ROSEN DMD
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Gender | Male
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 293 ROUTE 100 STE 202
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City | SOMERS
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State | NY
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Zip | 10589-3215
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Country | US
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Telephone | 914-277-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 293 ROUTE 100 STE 202
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City | SOMERS
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State | NY
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Zip | 10589-3215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN1856456
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN19008
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN19008
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 056647
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License Number State | NY
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