Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 19706 | PA |
NPI | 1023175080 |
---|---|
Provider Name | Dr. Edwin Rosenberg |
First Address | Philadelphia, PA 19102-4329 |
Second Address | Philadelphia, PA 19102-4329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |