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General NPI Number Information
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NPI Number | 1407810153
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Entity Type | Individual
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Provider Name | ELENA ROSEN OD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 200 WEST 24TH STREET MAXIMEYES OPTICAL
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City | NY
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State | NY
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Zip | 10011
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Country | US
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Telephone | 212-929-3693
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Fax | 212-929-1620
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Provider Business Mailing Address
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Address Line | 187 WOODBURY RD
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City | WOODBURY
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State | NY
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Zip | 11797
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Country | US
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Telephone | 516-367-1147
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUT0056811
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License Number State | NY
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