MEDICARE: DR. MIRI ROSEN MD

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	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	2084P0800X	Psychiatry Physician	267058	NY

General Provider Information

NPI Number	:	1215222815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRI ROSEN MD

Provider Business Mailing Address
First Line	:	1751 2ND AVE STE AZ5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-5363
Country	:	US
Telephone Number	:	212-235-7130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 2ND AVE STE AZ5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-5363
Country	:	US
Telephone Number	:	212-235-7130
Fax Number	:

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

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	11/22/2019

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