Provider Demographics
NPI:1447464979
Name:ROSEMAN, BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:ROSEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W 58TH ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1827
Mailing Address - Country:US
Mailing Address - Phone:212-957-8256
Mailing Address - Fax:212-265-2616
Practice Address - Street 1:330 W 58TH ST
Practice Address - Street 2:SUITE 408
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1827
Practice Address - Country:US
Practice Address - Phone:212-957-8256
Practice Address - Fax:212-265-2616
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine