Healthcare Provider Details

I. General information

NPI: 1063263580
Provider Name (Legal Business Name): JONATHAN M ROSENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2548 LEIGHTON AVE.
HENDERSON NV
89052
US

IV. Provider business mailing address

2321 BUCKINGHAM RUN CT
ORLANDO FL
32828
US

V. Phone/Fax

Practice location:
  • Phone: 702-821-5044
  • Fax:
Mailing address:
  • Phone: 702-821-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0126
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0126
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: