Provider Demographics
NPI:1699863357
Name:ROSEN, DANIEL D (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 1ST AVE APT 140
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4004
Mailing Address - Country:US
Mailing Address - Phone:212-545-1212
Mailing Address - Fax:
Practice Address - Street 1:1562 1ST AVE APT 140
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4004
Practice Address - Country:US
Practice Address - Phone:212-545-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1987642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244284Medicaid
NY00244284Medicaid
NY126591Medicare ID - Type Unspecified