Basic Information
Provider Information
NPI: 1609172592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSEMAN
FirstName: ADAM
MiddleName: JARETT
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 68 S SERVICE RD
Address2: SUITE 350
City: MELVILLE
State: NY
PostalCode: 117472354
CountryCode: US
TelephoneNumber: 5169453000
FaxNumber: 5169453131
Practice Location
Address1: 270-05 76TH AVE.
Address2: SUITE 2000
City: NEW HYDE PARK
State: NY
PostalCode: 11040
CountryCode: US
TelephoneNumber: 7184707390
FaxNumber: 7184706307
Other Information
ProviderEnumerationDate: 02/10/2011
LastUpdateDate: 06/02/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X257723NYY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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