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General NPI Number Information
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NPI Number | 1700204112
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Entity Type | Organization
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Legal Business Name | JEFFREY ROSENBERG
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 413 BAINBRIDGE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1537
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Country | US
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Telephone | 215-592-4747
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Fax | 215-592-8230
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Provider Business Mailing Address
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Address Line | 413 BAINBRIDGE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1537
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Country | US
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Telephone | 215-592-4747
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Fax | 215-592-8230
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MICHELLE SANTIAGO
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Credential |
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Telephone | 215-592-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS022998L
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License Number State | PA
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