Healthcare Provider Details

I. General information

NPI: 1669423042
Provider Name (Legal Business Name): ROBERT E ROSENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N CENTRAL AVE SUITE 303
HARTSDALE NY
10530-1832
US

IV. Provider business mailing address

280 N CENTRAL AVE SUITE 303
HARTSDALE NY
10530-1832
US

V. Phone/Fax

Practice location:
  • Phone: 914-271-5639
  • Fax: 914-271-5639
Mailing address:
  • Phone: 914-271-4727
  • Fax: 914-271-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number051565
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number179921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: