=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831288067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILTON ROSENBERG DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 JERICHO TURNPIKE
-----------------------------------------------------
City | NEW HYPE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-354-0033
-----------------------------------------------------
Fax | 516-354-0822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 JERICHO TURNPIKE
-----------------------------------------------------
City | NEW HYPE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-354-0033
-----------------------------------------------------
Fax | 516-354-0822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST OWNER
-----------------------------------------------------
Name | DR. MILTON ROSENBERG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 516-754-0033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 026078
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------