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NPI Code Detail

MEDICARE: GARY NELSON ROSENBERG D.O.

MEDICARE: GARY NELSON ROSENBERG D.O.
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
12084P0800XPsychiatry Physician220996NY

General Provider Information

NPI Number : 1740389378
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY NELSON ROSENBERG D.O.
Provider Business Mailing Address
First Line : 1111 ELMWOOD AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-3005
Country : US
Telephone Number : 585-241-1369
Fax Number :
Provider Business Practice Location Address
First Line : 1111 ELMWOOD AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-3005
Country : US
Telephone Number : 585-241-1369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 07/08/2007

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