Healthcare Provider Details

I. General information

NPI: 1790773406
Provider Name (Legal Business Name): KENNETH Y ROSENTHAL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W ARLINGTON BLVD STE D
GREENVILLE NC
27834-5709
US

IV. Provider business mailing address

2140 W ARLINGTON BLVD STE D
GREENVILLE NC
27834-5709
US

V. Phone/Fax

Practice location:
  • Phone: 252-830-1000
  • Fax: 252-830-0511
Mailing address:
  • Phone: 252-830-1000
  • Fax: 252-830-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number485
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: