Healthcare Provider Details

I. General information

NPI: 1467448050
Provider Name (Legal Business Name): JOHN DANIEL ROSENBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 E MAIN ST
WESTFIELD NY
14787-1155
US

IV. Provider business mailing address

158 E MAIN ST
WESTFIELD NY
14787-1155
US

V. Phone/Fax

Practice location:
  • Phone: 716-326-4686
  • Fax: 716-326-4628
Mailing address:
  • Phone: 716-326-4686
  • Fax: 716-326-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD482302
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number156606-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: