Bruce Rosen, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

112715 Issued in NY

Practice address

222 Middle Country Rd
Suite 210
Smithtown, NY 11787-2814

Phone

(631) 265-6868

Fax

(631) 265-6890

NPI assigned

Nov 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 4, 2023 through Oct 4, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: brosen12715@direct-chsli.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208304000000",
    "number": "1649343245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 MIDDLE COUNTRY RD",
            "address_2": "SUITE 210",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872814",
            "telephone_number": "631-265-6868",
            "fax_number": "631-265-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 MIDDLE COUNTRY RD",
            "address_2": "SUITE 210",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872814",
            "telephone_number": "631-265-6868",
            "fax_number": "631-265-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSEN",
        "first_name": "BRUCE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2008-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "112715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00204173",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Lynn Rosati, LMT
• Joyce Anne Roschnotti, LMT
• Annemarie Rosciano, NP
• Michael Rose, LCSW-R
• Roseann de Franco, Ms, CCC-SLP, P.C.
• Michael Edward Rosenband, M.D.
• Amanda Mae Rosenfeld, RPA-C
• Paul Myron Rosenthal, O.D.
• Annmarie Rosina, PT
• Ross Optical Incorporated (21st Century Optical)

• Psychiatry Physician in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; 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.

Verify at the official NPI Registry.