1639226848 NPI number — MR. MICHAEL ELIAS ROSENBAUM

Table of content: MR. MICHAEL ELIAS ROSENBAUM (NPI 1639226848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639226848 NPI number — MR. MICHAEL ELIAS ROSENBAUM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBAUM
Provider First Name:
MICHAEL
Provider Middle Name:
ELIAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1639226848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16077 ASHLAND AVE
Provider Second Line Business Mailing Address:
APT. NO. 396
Provider Business Mailing Address City Name:
SAN LORENZO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94580-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-553-8500
Provider Business Mailing Address Fax Number:
510-553-8550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 BANCROFT AVE
Provider Second Line Business Practice Location Address:
EASTMONT TOWN CENTER BLDG. B. SUITE 133
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94605-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-553-8500
Provider Business Practice Location Address Fax Number:
510-553-8550
Provider Enumeration Date:
01/03/2007

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1801983960 . This is a "ICM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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