Healthcare Provider Details

I. General information

NPI: 1265529341
Provider Name (Legal Business Name): LISA D ROSENBERG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST # STARR-607
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

520 E 70TH ST # STARR-607
NEW YORK NY
10021-9800
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2344
  • Fax: 212-746-8532
Mailing address:
  • Phone: 212-746-0373
  • Fax: 212-746-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number012753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: