Healthcare Provider Details

I. General information

NPI: 1346262193
Provider Name (Legal Business Name): ROGER D ROSENSTOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 LANTANA RD SUITE 100
LAKE WORTH FL
33462-1329
US

IV. Provider business mailing address

3450 LANTANA RD SUITE 100
LAKE WORTH FL
33462-1329
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-1864
  • Fax: 561-967-5005
Mailing address:
  • Phone: 561-965-1864
  • Fax: 561-967-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME0022513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: