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General NPI Number Information
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NPI Number | 1376295022
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Entity Type | Organization
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Legal Business Name | NICHOLAS ROSENLICHT MD INC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 526 VINCENTE AVE
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City | BERKELEY
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State | CA
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Zip | 94707-1522
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Country | US
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Telephone | 510-558-3488
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Fax | 855-558-3488
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Provider Business Mailing Address
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Address Line | 1569 SOLANO AVE # 324
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City | BERKELEY
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State | CA
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Zip | 94707-2116
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Country | US
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Telephone | 510-558-3488
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Fax | 510-558-3488
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICHOLAS ROSENLICHT
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Credential | MD
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Telephone | 510-558-3488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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