MEDICARE: BAILEY ROSEN ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	68011195	NY

General Provider Information

NPI Number	:	1013386168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY ROSEN ED.D.

Provider Business Mailing Address
First Line	:	605 W 112TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-1836
Country	:	US
Telephone Number	:	202-427-3974
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 W 112TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-1836
Country	:	US
Telephone Number	:	202-427-3974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	09/18/2015

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Directions to “ BAILEY ROSEN ED.D.” Practice Location

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