Healthcare Provider Details

I. General information

NPI: 1063406486
Provider Name (Legal Business Name): ALEKSANDR V. ROZENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W BRIGHTON AVE
BROOKLYN NY
11224-4902
US

IV. Provider business mailing address

108 BURNHAM AVE
ROSLYN HEIGHTS NY
11577-1935
US

V. Phone/Fax

Practice location:
  • Phone: 718-627-8300
  • Fax: 718-627-8302
Mailing address:
  • Phone: 917-697-7817
  • Fax: 516-625-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number232855-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: