Healthcare Provider Details

I. General information

NPI: 1861968463
Provider Name (Legal Business Name): GERALD ROSENBERG MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 GEMINI PL STE 300
COLUMBUS OH
43240-6112
US

IV. Provider business mailing address

10933 MORSE RD SW
PATASKALA OH
43062-8692
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-6450
  • Fax:
Mailing address:
  • Phone: 614-306-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GERALD ROSENBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 614-306-6202