Healthcare Provider Details

I. General information

NPI: 1336107564
Provider Name (Legal Business Name): JONATHAN A. ROSENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 BOSTON ROAD
WILBRAHAM MA
01095
US

IV. Provider business mailing address

2207 BOSTON ROAD
WILBRAHAM MA
01095
US

V. Phone/Fax

Practice location:
  • Phone: 413-599-1201
  • Fax: 413-596-2940
Mailing address:
  • Phone: 413-599-1201
  • Fax: 413-596-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74845
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: