Healthcare Provider Details

I. General information

NPI: 1962587725
Provider Name (Legal Business Name): DAVID L ROSENSTREICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 BLONDELL AVE
BRONX NY
10461-2601
US

IV. Provider business mailing address

1515 BLONDELL AVE
BRONX NY
10461-2601
US

V. Phone/Fax

Practice location:
  • Phone: 866-633-8255
  • Fax: 718-405-8322
Mailing address:
  • Phone: 866-633-8255
  • Fax: 718-405-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number140453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: