Active NPI
Robin B Forman Rose, D.O.
- Gastroenterology Physician
- Ridgefield, CT
National Provider Identifier
1336287515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 45319
- Practice address
- 38C Grove St
Ridgefield, CT 06877-4669 - Phone
- (203) 900-4416
- Fax
- (203) 666-5649
- NPI assigned
- Feb 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 45319 | CT | Primary |
Addresses
Primary practice location
38C Grove St
Ridgefield, CT 06877-4669
Mailing address
38C Grove St
Ridgefield, CT 06877-4669
Phone (203) 900-4416
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 25, 2022 through Jan 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45319 | CT | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625702400000",
"number": "1336287515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38C GROVE ST",
"city": "RIDGEFIELD",
"state": "CT",
"postal_code": "068774669",
"telephone_number": "203-900-4416",
"fax_number": "203-666-5649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38C GROVE ST",
"city": "RIDGEFIELD",
"state": "CT",
"postal_code": "068774669",
"telephone_number": "203-900-4416",
"fax_number": "203-666-5649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN ROSE",
"first_name": "ROBIN",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2021-07-08",
"certification_date": "2021-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "CT",
"license": "45319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgefield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.