Healthcare Provider Details

I. General information

NPI: 1700817178
Provider Name (Legal Business Name): DARA JEAN ROSENBERG DDS, MS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183RD STREET AND THIRD AVENUE ST BARNABAS HOSPITAL, DEPARTMENT OF DENTISTRY
BRONX NY
10457
US

IV. Provider business mailing address

183RD STREET AND THIRD AVENUE ST BARNABAS HOSPITAL, DEPARTMENT OF DENTISTRY
BRONX NY
10457
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6498
  • Fax: 718-960-3663
Mailing address:
  • Phone: 718-960-6498
  • Fax: 718-960-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number035933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: