Provider Demographics
NPI:1699765651
Name:ROSEN, PAUL IRA (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:IRA
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1928
Mailing Address - Country:US
Mailing Address - Phone:516-364-9540
Mailing Address - Fax:
Practice Address - Street 1:8928 MERRICK BLVD
Practice Address - Street 2:100 WASHINGTON ST. HEMPSTEAD NY 11550
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5243
Practice Address - Country:US
Practice Address - Phone:718-291-9456
Practice Address - Fax:718-558-0861
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0318621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice