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General NPI Number Information
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NPI Number | 1982759049
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Entity Type | Individual
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Provider Name | SIMON WALTER ROSENBERG D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 399 E 72ND ST SUITE #1A
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City | NEW YORK
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State | NY
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Zip | 10021-4648
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Country | US
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Telephone | 212-988-8822
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Fax | 212-988-8858
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Provider Business Mailing Address
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Address Line | 399 E 72ND ST SUITE #1A
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City | NEW YORK
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State | NY
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Zip | 10021-4648
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Country | US
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Telephone | 212-988-8822
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Fax | 212-988-8858
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 33545
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License Number State | NY
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