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NPI Code Detail

MEDICARE: NICHOLAS ROSENLICHT MD INC

MEDICARE: NICHOLAS ROSENLICHT MD INC
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
1261QM2500XMedical Specialty Clinic/Center

General Provider Information

NPI Number : 1376295022
Entity Type Code : Organization
Provider Name (Legal Business Name) : NICHOLAS ROSENLICHT MD INC
Provider Business Mailing Address
First Line : 1569 SOLANO AVE # 324
Second Line :
City : BERKELEY
State : CA
Zip : 94707-2116
Country : US
Telephone Number : 510-558-3488
Fax Number : 510-558-3488
Provider Business Practice Location Address
First Line : 526 VINCENTE AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94707-1522
Country : US
Telephone Number : 510-558-3488
Fax Number : 855-558-3488
Authorized Official
Title or Position : PRESIDENT
Name : NICHOLAS ROSENLICHT
Credential : MD
Telephone Number : 510-558-3488
Provider Enumeration Date : 01/24/2022
Last Update Date : 04/15/2022

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Directions to “NICHOLAS ROSENLICHT MD INC ” Practice Location

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