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General NPI Number Information
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NPI Number | 1861647042
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Entity Type | Organization
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Legal Business Name | KENNETH J ROSENTHAL MD PC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 310 E SHORE RD SUITE 102
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City | GREAT NECK
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State | NY
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Zip | 11023-2432
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Country | US
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Telephone | 516-466-8989
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Fax | 516-466-8962
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Provider Business Mailing Address
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Address Line | 310 E SHORE RD SUITE 102
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City | GREAT NECK
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State | NY
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Zip | 11023-2432
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Country | US
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Telephone | 516-466-8989
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Fax | 516-466-8962
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Authorized Official
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Title or Position | PRESIDENT / SURGEON
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Name | DR. KENNETH J ROSENTHAL
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Credential | MD
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Telephone | 516-466-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 138603
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License Number State | NY
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