Healthcare Provider Details

I. General information

NPI: 1265541122
Provider Name (Legal Business Name): NICHOLAS ZINGARELLI ROSENLICHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 SOLANO AVE # 324
BERKELEY CA
94707-2116
US

IV. Provider business mailing address

1569 SOLANO AVE # 324
BERKELEY CA
94707-2116
US

V. Phone/Fax

Practice location:
  • Phone: 510-558-3488
  • Fax: 855-558-3489
Mailing address:
  • Phone: 510-558-3488
  • Fax: 855-558-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA41891
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA41891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: