Provider Demographics
NPI:1750401865
Name:ROSEN SERVICE GROUP, LLC
Entity type:Organization
Organization Name:ROSEN SERVICE GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:201-785-8998
Mailing Address - Street 1:26 N DE BAUN AVE
Mailing Address - Street 2:APT 208
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5125
Mailing Address - Country:US
Mailing Address - Phone:845-357-6797
Mailing Address - Fax:
Practice Address - Street 1:145 N FRANKLIN TPKE
Practice Address - Street 2:SUITE 204
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1602
Practice Address - Country:US
Practice Address - Phone:201-785-8998
Practice Address - Fax:201-961-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05166900OtherLCSW
NYR-070364OtherLCSW
NJ112368Medicare PIN