Provider Demographics
NPI:1104911312
Name:ROSEN, ERIC STEPHAN (DPM)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:STEPHAN
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 FALLER DR
Mailing Address - Street 2:APT C
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-5228
Mailing Address - Country:US
Mailing Address - Phone:201-288-3000
Mailing Address - Fax:201-288-6434
Practice Address - Street 1:261 FALLER DR
Practice Address - Street 2:APT C
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-5228
Practice Address - Country:US
Practice Address - Phone:201-288-3000
Practice Address - Fax:201-288-6434
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2017-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02379213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7418701Medicaid
NJ7418701Medicaid
NJRO909566Medicare ID - Type Unspecified