Healthcare Provider Details

I. General information

NPI: 1336134691
Provider Name (Legal Business Name): DAVID ROSENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PENINSULA BLVD
CEDARHURST NY
11516-1129
US

IV. Provider business mailing address

320 PENINSULA BLVD
CEDARHURST NY
11516-1129
US

V. Phone/Fax

Practice location:
  • Phone: 516-569-2323
  • Fax: 516-569-4131
Mailing address:
  • Phone: 516-569-2323
  • Fax: 516-569-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228698
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02495563
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: