MEDICARE: SY H ROSEN C.O.

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	222Z00000X	Orthotist	213000062	IL
2	224P00000X	Prosthetist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	99322112	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1043278138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SY H ROSEN C.O.

Provider Business Mailing Address
First Line	:	3549 GROVE ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60203-1819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9933 LAWLER AVE
Second Line	:	#409
City	:	SKOKIE
State	:	IL
Zip	:	60077-3703
Country	:	US
Telephone Number	:	847-410-2751
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	02/12/2013

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Directions to “ SY H ROSEN C.O.” Practice Location

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