MEDICARE: DR. ALEKSANDR V. ROZENBERG M.D.

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	207L00000X	Anesthesiology Physician	232855-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	ARO9L16510	OTHER	NY	MEDICARE PROVIDR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1063406486	OTHER	NY	NPI
3	9L165ANH21	OTHER	NY	PTAN

General Provider Information

NPI Number	:	1063406486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEKSANDR V. ROZENBERG M.D.

Provider Business Mailing Address
First Line	:	108 BURNHAM AVE
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1935
Country	:	US
Telephone Number	:	917-697-7817
Fax Number	:	516-625-4974

Provider Business Practice Location Address
First Line	:	40 W BRIGHTON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4902
Country	:	US
Telephone Number	:	718-627-8300
Fax Number	:	718-627-8302

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	01/05/2016

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