MEDICARE: MR. LOUIS ALFRED ROSE DO

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	332BC3200X	Customized Equipment (DME)	C13828	NY
2	332B00000X	Durable Medical Equipment & Medical Supplies	C13828	NY

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	:	1497869663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOUIS ALFRED ROSE DO

Provider Business Mailing Address
First Line	:	3146 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5706
Country	:	US
Telephone Number	:	718-409-6280
Fax Number	:	718-409-4110

Provider Business Practice Location Address
First Line	:	3146 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5706
Country	:	US
Telephone Number	:	718-409-6280
Fax Number	:	718-409-4110

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	10/07/2021

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