Provider Demographics
NPI:1871596262
Name:ROSEN, BARRY JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAY
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5847 FRANCIS LEWIS BLVD
Mailing Address - Street 2:STE 11
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1698
Mailing Address - Country:US
Mailing Address - Phone:718-225-2424
Mailing Address - Fax:718-225-2425
Practice Address - Street 1:5847 FRANCIS LEWIS BLVD
Practice Address - Street 2:STE 11
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1601
Practice Address - Country:US
Practice Address - Phone:718-225-2424
Practice Address - Fax:718-225-2425
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN003625213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00791057Medicaid
NYT31819Medicare UPIN
NY00791057Medicaid
NY27254AMedicare UPIN
480002882Medicare UPIN
0250690001Medicare NSC
NY00791057Medicaid