MEDICARE: DR. MARNIE E ROSENTHAL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	25MB08514100	NJ

General Provider Information

NPI Number	:	1790733921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARNIE E ROSENTHAL D.O.

Provider Business Mailing Address
First Line	:	2240 STATE ROUTE 33
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6104
Country	:	US
Telephone Number	:	732-897-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 STATE ROUTE 33
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6104
Country	:	US
Telephone Number	:	732-897-3991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/23/2010

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