1427054782 NPI number — CYNTHIA ROSENTHAL D.O.

Table of content: CYNTHIA ROSENTHAL D.O. (NPI 1427054782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427054782 NPI number — CYNTHIA ROSENTHAL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENTHAL
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427054782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 MONTAUK HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11795-4927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-376-3000
Provider Business Mailing Address Fax Number:
631-224-8560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 MONTAUK HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11795-4927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-376-3000
Provider Business Practice Location Address Fax Number:
631-224-8560
Provider Enumeration Date:
06/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0203X , with the licence number:  195868 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 86952 . This is a "VYTRA HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1047235 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01806202 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2C2617 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 76-86062 . This is a "UHC CHILD HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 43N221 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0522690 . This is a "AETNA/US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4265641 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 46386 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6101386 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426010670 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AA50732 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010195868NY01 . This is a "ANTHEM NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".