Active NPI
Russell Rosen, R.PH.
- Pharmacist
- Lakewood, NJ
National Provider Identifier
1356699565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17278
- Practice address
- 1771 Madison Ave
Lakewood, NJ 08701-1251 - Phone
- (732) 534-8559
- NPI assigned
- Aug 17, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17278 | NJ | Primary |
| Pharmacist | 183500000X | 35572 | NY |
Addresses
Primary practice location
1771 Madison Ave
Lakewood, NJ 08701-1251
Mailing address
11 Darlington Dr
Manalapan, NJ 07726-4224
Phone (917) 577-2643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35572 | NY | MD | Addiction (Substance Use Disorder) Counselor |
| 17278 | NJ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345161600000",
"number": "1356699565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 DARLINGTON DR",
"city": "MANALAPAN",
"state": "NJ",
"postal_code": "077264224",
"telephone_number": "917-577-2643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1771 MADISON AVE",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087011251",
"telephone_number": "732-534-8559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSEN",
"first_name": "RUSSELL",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-17",
"last_updated": "2012-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "17278",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "35572",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.