MEDICARE: JEFFREY DAVID 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	207VG0400X	Gynecology Physician	25MA07901100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356376206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DAVID ROSEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 558
Second Line	:
City	:	LUDLOW
State	:	VT
Zip	:	05149-0558
Country	:	US
Telephone Number	:	716-863-2907
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N BROAD ST
Second Line	:	SUITE 202
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-2310
Country	:	US
Telephone Number	:	888-428-4588
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/25/2008

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Directions to “ JEFFREY DAVID ROSEN M.D.” Practice Location

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