Healthcare Provider Details

I. General information

NPI: 1376295022
Provider Name (Legal Business Name): NICHOLAS ROSENLICHT MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 VINCENTE AVE
BERKELEY CA
94707-1522
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: 855-558-3488
Mailing address:
  • Phone: 510-558-3488
  • Fax: 510-558-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS ROSENLICHT
Title or Position: PRESIDENT
Credential: MD
Phone: 510-558-3488