1700817178 NPI number — DR. DARA JEAN ROSENBERG DDS, MS, MPH

Table of content: DR. DARA JEAN ROSENBERG DDS, MS, MPH (NPI 1700817178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700817178 NPI number — DR. DARA JEAN ROSENBERG DDS, MS, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBERG
Provider First Name:
DARA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MS, MPH
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:
1700817178
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:
183RD STREET AND THIRD AVENUE
Provider Second Line Business Mailing Address:
ST BARNABAS HOSPITAL, DEPARTMENT OF DENTISTRY
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-960-6498
Provider Business Mailing Address Fax Number:
718-960-3663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183RD STREET AND THIRD AVENUE
Provider Second Line Business Practice Location Address:
ST BARNABAS HOSPITAL, DEPARTMENT OF DENTISTRY
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-960-6498
Provider Business Practice Location Address Fax Number:
718-960-3663
Provider Enumeration Date:
07/05/2006

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: 122300000X , with the licence number:  035933 , 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)





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