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General NPI Number Information
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NPI Number | 1487623112
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Entity Type | Individual
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Provider Name | CARLOS ALBERTO DE LA ROSA OD
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Gender | Male
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 3777 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1541
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Country | US
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Telephone | 212-926-0336
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Fax | 212-926-0212
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Provider Business Mailing Address
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Address Line | 57 HERRICK AVE
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City | TEANECK
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State | NJ
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Zip | 07666
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Country | US
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Telephone | 212-926-0336
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Fax | 212-926-0212
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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 | 270A00534900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV005619
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License Number State | NY
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