Healthcare Provider Details

I. General information

NPI: 1639599293
Provider Name (Legal Business Name): ELYSE SARAH ROSENTHAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S HENDERSON RD STE 108
KING OF PRUSSIA PA
19406-3530
US

IV. Provider business mailing address

700 S HENDERSON RD STE 108
KING OF PRUSSIA PA
19406-3530
US

V. Phone/Fax

Practice location:
  • Phone: 484-207-5624
  • Fax: 484-873-1689
Mailing address:
  • Phone: 484-207-5624
  • Fax: 484-873-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS018627
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: