MEDICARE: GERALD ROSEN MD INC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1699808568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD ROSEN MD INC

Provider Business Mailing Address
First Line	:	25 ANN ST
Second Line	:	APT. #10
City	:	NEW YORK
State	:	NY
Zip	:	10038-2404
Country	:	US
Telephone Number	:	212-284-0044
Fax Number	:	212-604-6024

Provider Business Practice Location Address
First Line	:	25 ANN ST
Second Line	:	APT. #10
City	:	NEW YORK
State	:	NY
Zip	:	10038-2404
Country	:	US
Telephone Number	:	212-284-0044
Fax Number	:	212-604-6024

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GERALD ROSEN
Credential	:	M.D.
Telephone Number	:	212-285-0044

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/25/2010

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