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General NPI Number Information
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NPI Number | 1669889119
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Entity Type | Individual
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Provider Name | JARED MATTHEW ROSENSTOCK MD, DMD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 225 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10007-3001
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Country | US
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Telephone | 212-732-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 1438 3RD AVE APT 9A
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City | NEW YORK
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State | NY
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Zip | 10028-1963
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 060116
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License Number State | NY
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