Individual
DR. PETER A ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
3304 BELL BLVD, BAYSIDE, NY 11361-1603
(718) 428-8900
Mailing address
3304 BELL BLVD, BAYSIDE, NY 11361-1603
(718) 428-8900
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
050684
NY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
252694
NY
Other
Enumeration date
12/08/2007
Last updated
10/14/2011
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