1992802474 NPI number — EDWARD S. ROSENTHAL, MD., LLC

Table of content: (NPI 1992802474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992802474 NPI number — EDWARD S. ROSENTHAL, MD., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD S. ROSENTHAL, MD., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1992802474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12000 MCCRACKEN RD
Provider Second Line Business Mailing Address:
SUITE 453
Provider Business Mailing Address City Name:
GARFIELD HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44125-2933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-581-4900
Provider Business Mailing Address Fax Number:
216-581-7370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12000 MCCRACKEN RD
Provider Second Line Business Practice Location Address:
SUITE 453
Provider Business Practice Location Address City Name:
GARFIELD HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44125-2933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-581-4900
Provider Business Practice Location Address Fax Number:
216-581-7370
Provider Enumeration Date:
09/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENTHAL
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
216-581-4900

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35-053841 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2725000 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com