MEDICARE: DR. VICTOR ROSENSON DDS

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	1223G0001X	General Practice Dentistry	22DI02275400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205814976	OTHER	NJ	TAX ID

General Provider Information

NPI Number	:	1275515231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR ROSENSON DDS

Provider Business Mailing Address
First Line	:	625 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-3401
Country	:	US
Telephone Number	:	917-282-1604
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-3401
Country	:	US
Telephone Number	:	973-423-4841
Fax Number	:	973-423-4841

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	05/05/2008

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