Healthcare Provider Details

I. General information

NPI: 1053351684
Provider Name (Legal Business Name): ALLEN J ROSENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-3924
  • Fax: 504-896-9733
Mailing address:
  • Phone: 504-412-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD.04040R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: