1093716219 NPI number — DR. GENE S ROSENBERG M.D.

Table of content: DR. GENE S ROSENBERG M.D. (NPI 1093716219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093716219 NPI number — DR. GENE S ROSENBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBERG
Provider First Name:
GENE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1093716219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PROSPECT AVE
Provider Second Line Business Mailing Address:
SUITE 915
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-1997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-343-0082
Provider Business Mailing Address Fax Number:
201-488-1203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE 915
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-343-0082
Provider Business Practice Location Address Fax Number:
201-488-1203
Provider Enumeration Date:
08/10/2005

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: 208800000X , with the licence number:  25MA03648000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01000052800 . This is a "AMERICHOICE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5S1651 . This is a "BCBS NY CARLSTADT" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0107212000 . This is a "AMERIHEALTH HMO ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 21A961 . This is a "BC/BS NY (HACKENSACK) #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3055507 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4093305 . This is a "AETNA PPO ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0049819 . This is a "AETNA HMO ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: BS025 . This is a "OXFORD ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1099931 . This is a "GHI PPO ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 340010235 . This is a "RAILROAD MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4819209 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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