Healthcare Provider Details
I. General information
NPI: 1093716219
Provider Name (Legal Business Name): GENE S ROSENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/10/2005
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
20 PROSPECT AVE SUITE 915
HACKENSACK NJ
07601-1997
US
IV. Provider business mailing address
20 PROSPECT AVE SUITE 915
HACKENSACK NJ
07601-1997
US
V. Phone/Fax
- Phone: 201-343-0082
- Fax: 201-488-1203
- Phone: 201-343-0082
- Fax: 201-488-1203
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208800000X |
| Taxonomy | Urology Physician |
| License Number | 25MA03648000 |
| License Number State | NJ |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 01000052800 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AMERICHOICE # |
| # 2 | |
| Identifier | 5S1651 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | BCBS NY CARLSTADT |
| # 3 | |
| Identifier | 0107212000 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AMERIHEALTH HMO ID # |
| # 4 | |
| Identifier | 21A961 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | BC/BS NY (HACKENSACK) # |
| # 5 | |
| Identifier | 3055507 |
| Identifier Type | MEDICAID |
| Identifier State | NJ |
| Identifier Issuer | |
| # 6 | |
| Identifier | 4093305 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AETNA PPO ID # |
| # 7 | |
| Identifier | 0049819 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AETNA HMO ID # |
| # 8 | |
| Identifier | BS025 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | OXFORD ID # |
| # 9 | |
| Identifier | 1099931 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | GHI PPO ID # |
| # 10 | |
| Identifier | 340010235 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | RAILROAD MDCR # |
| # 11 | |
| Identifier | 4819209 |
| Identifier Type | MEDICAID |
| Identifier State | NJ |
| Identifier Issuer | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
