1104981877 NPI number — ERIC ROSENBERG D.P.M.

Table of content: ERIC ROSENBERG D.P.M. (NPI 1104981877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104981877 NPI number — ERIC ROSENBERG D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBERG
Provider First Name:
ERIC
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1104981877
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:
821 WOODMERE CT
Provider Second Line Business Mailing Address:
APT. 1C
Provider Business Mailing Address City Name:
WOODMERE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11598-2552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-295-0825
Provider Business Mailing Address Fax Number:
516-295-0825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 WOODMERE CT
Provider Second Line Business Practice Location Address:
APT. 1C
Provider Business Practice Location Address City Name:
WOODMERE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11598-2552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-295-0825
Provider Business Practice Location Address Fax Number:
516-295-0825
Provider Enumeration Date:
12/23/2006

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: 213E00000X , with the licence number:  N004792-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 213ES0131X , with the licence number: N004792-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1042323 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C6729 . This is a "ACS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4950990001 . This is a "MEDICARE DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9131217 . This is a "CIGNA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01302785 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59872 . This is a "VYTRA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6200506 . This is a "GROUP HEALTH INCORPORATED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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