1619988086 NPI number — DR. CLIVE ROSENDORFF M.D., PH.D.

Table of content: DR. CLIVE ROSENDORFF M.D., PH.D. (NPI 1619988086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619988086 NPI number — DR. CLIVE ROSENDORFF M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENDORFF
Provider First Name:
CLIVE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.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:
1619988086
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:
333 CENTRAL PARK W
Provider Second Line Business Mailing Address:
APARTMENT 83
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10025-7145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-865-3674
Provider Business Mailing Address Fax Number:
718-741-4292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 W KINGSBRIDGE RD
Provider Second Line Business Practice Location Address:
MEDICINE (111) , JJP VAMC
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-741-4292
Provider Business Practice Location Address Fax Number:
718-741-4233
Provider Enumeration Date:
08/11/2006

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: 207RC0000X , with the licence number:  186625-1 , 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: 02516172 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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