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General NPI Number Information
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NPI Number | 1962451989
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Entity Type | Individual
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Provider Name | MATTHEW ROSEN PHD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 873 ROUTE 45 SUITE 204A
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City | NEW CITY
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State | NY
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Zip | 10956-1116
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Country | US
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Telephone | 845-213-8761
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Fax | 845-459-6230
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Provider Business Mailing Address
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Address Line | 873 ROUTE 45 SUITE 204A
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City | NEW CITY
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State | NY
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Zip | 10956-1116
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Country | US
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Telephone | 845-213-8761
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Fax | 845-459-6230
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8040
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License Number State | NY
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