MEDICARE: ROSETTA GENOMICS, 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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1760915458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSETTA GENOMICS, INC

Provider Business Mailing Address
First Line	:	3711 MARKET ST STE 740
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5535
Country	:	US
Telephone Number	:	949-587-7516
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 MARKET ST STE 740
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5535
Country	:	US
Telephone Number	:	949-587-7516
Fax Number	:

Authorized Official
Title or Position	:	BILLING ADMINSTRATOR
Name	:	BRENDA HALL
Credential	:
Telephone Number	:	215-382-9002

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	04/10/2017

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