1780653998 NPI number — BARRY ROSENBERG

Table of content: BARRY ROSENBERG (NPI 1780653998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780653998 NPI number — BARRY ROSENBERG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBERG
Provider First Name:
BARRY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1780653998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 NORTH ST
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
BATAVIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14020-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-267-7510
Provider Business Mailing Address Fax Number:
585-267-7511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATAVIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14020-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-344-5225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2006

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: 2085R0202X , with the licence number:  215093 , 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: 00026344402 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040608000051 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010215093 . This is a "ROCHESTER BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2150936B . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00137247 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02000264 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103432FF . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P020215093 . This is a "ROCHESTER BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000916872003 . This is a "BLUE SHIELD OF WESTERN NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1691700 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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