Individual
DR. CARLOS ALBERTO DE LA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3777 BROADWAY, NEW YORK, NY 10032-1541
(212) 926-0336
(212) 926-0212
Mailing address
57 HERRICK AVE, TEANECK, NJ 07666
(212) 926-0336
(212) 926-0212
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
270A00534900
NJ
152W00000X
Optometrist
Primary
TUV005619
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01759824
—
NY
05
—
3087018
—
NJ
Enumeration date
03/15/2006
Last updated
07/08/2008
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