1013282615 NPI number — DR. NATALYA GOBERMAN-ROSENSTOCK M.D.

Table of content: DR. NATALYA GOBERMAN-ROSENSTOCK M.D. (NPI 1013282615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013282615 NPI number — DR. NATALYA GOBERMAN-ROSENSTOCK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOBERMAN-ROSENSTOCK
Provider First Name:
NATALYA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSENSTOCK
Provider Other First Name:
NATALYA
Provider Other Middle Name:
GOBERMAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013282615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 290213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11229-0213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-366-4324
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 DAIBES CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07020-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-366-4324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2012

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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