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General NPI Number Information
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NPI Number | 1891812087
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Entity Type | Organization
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Legal Business Name | JERRY H ROSENBERG MD
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 67250 INDUSTRY LN SUITE B
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City | COVINGTON
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State | LA
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Zip | 70433-8716
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Country | US
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Telephone | 985-892-3456
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Fax | 985-892-3499
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Provider Business Mailing Address
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Address Line | 4224 HOUMA BLVD 260
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City | METAIRIE
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State | LA
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Zip | 70006-2933
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Country | US
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Telephone | 504-887-5555
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Fax | 504-888-5031
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | JONELLE W COUCH
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Credential |
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Telephone | 55048875555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 010614
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License Number State | LA
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