Healthcare Provider Details

I. General information

NPI: 1114902681
Provider Name (Legal Business Name): STEVEN ROSENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/18/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 14TH ST STE 401
NEW YORK NY
10003-4284
US

IV. Provider business mailing address

310 E 14TH ST STE 401
NEW YORK NY
10003-4284
US

V. Phone/Fax

Practice location:
  • Phone: 212-387-9294
  • Fax: 212-979-4564
Mailing address:
  • Phone: 212-387-9294
  • Fax: 212-979-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number204008
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number204008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: