Individual
JEFFREY ROSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5645 MAIN ST, 4TH FLOOR SOUTH, FLUSHING, NY 11355-5045
(718) 670-1422
Mailing address
5645 MAIN ST, 4TH FLOOR SOUTH, FLUSHING, NY 11355-5045
(718) 670-1422
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
198804
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00669
MEDICARE GRP
NY
05
—
01953539
—
NY
01
—
A400011399
MEDICARE PTAN
NY
01
—
G400000332
MEDICARE PTAN
NY
Enumeration date
09/23/2005
Last updated
06/02/2023
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