Provider Demographics
NPI:1265919179
Name:ROSEN, RIAN (PA)
Entity type:Individual
Prefix:
First Name:RIAN
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MADISON AVE RM 503
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1175
Mailing Address - Country:US
Mailing Address - Phone:212-585-3242
Mailing Address - Fax:866-401-0389
Practice Address - Street 1:420 MADISON AVE RM 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1175
Practice Address - Country:US
Practice Address - Phone:212-585-3242
Practice Address - Fax:866-401-0389
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology