MEDICARE: MICHAEL ROSEN,DDS,PC

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	039061	NY

General Provider Information

NPI Number	:	1346395571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL ROSEN,DDS,PC

Provider Business Mailing Address
First Line	:	566 LIDO LN
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1523
Country	:	US
Telephone Number	:	917-349-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 W 6TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2645
Country	:	US
Telephone Number	:	718-382-7338
Fax Number	:

Authorized Official
Title or Position	:	PREISDENT
Name	:	MICHAEL ROSEN
Credential	:	D.D.S.
Telephone Number	:	917-349-6252

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	01/12/2011

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