MEDICARE: DR. DALE ROSIN D.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	2084P0800X	Psychiatry Physician	25MB04750300	NJ
2	2084P0800X	Psychiatry Physician	OS009589L	PA

General Provider Information

NPI Number	:	1316283708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE ROSIN D.O.

Provider Business Mailing Address
First Line	:	129 GROVE ST
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-1922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 GROVE ST
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-1922
Country	:	US
Telephone Number	:	908-526-5095
Fax Number	:	908-218-1588

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

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	12/12/2012

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Directions to “ DR. DALE ROSIN D.O.” Practice Location

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