MEDICARE: DR. CRAIG ROSENBAUM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	043046	NY

General Provider Information

NPI Number	:	1063401560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG ROSENBAUM DDS

Provider Business Mailing Address
First Line	:	3304 91ST ST
Second Line	:	SUITE #1W
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1752
Country	:	US
Telephone Number	:	718-899-4455
Fax Number	:	718-899-4455

Provider Business Practice Location Address
First Line	:	3304 91ST ST
Second Line	:	SUITE #1W
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1752
Country	:	US
Telephone Number	:	718-899-4455
Fax Number	:	718-899-4455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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