Healthcare Provider Details

I. General information

NPI: 1003065335
Provider Name (Legal Business Name): IZABELLA ROZENTAL OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LEE BLVD
YORKTOWN HEIGHTS NY
10598-1100
US

IV. Provider business mailing address

650 LEE BLVD
YORKTOWN HEIGHTS NY
10598-1100
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-8111
  • Fax: 914-245-1826
Mailing address:
  • Phone: 914-245-8111
  • Fax: 914-245-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number006921-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: