MEDICARE: LARRY S ROSEN M.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	207V00000X	Obstetrics & Gynecology Physician	MA0407440	NJ

General Provider Information

NPI Number	:	1104806868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY S ROSEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 536
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-0536
Country	:	US
Telephone Number	:	856-669-6050
Fax Number	:	856-651-0794

Provider Business Practice Location Address
First Line	:	2301 E EVESHAM RD
Second Line	:	SUITE 602
City	:	VOORHEES
State	:	NJ
Zip	:	08043-4501
Country	:	US
Telephone Number	:	856-772-2066
Fax Number	:	856-772-9159

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	10/16/2014

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