Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 134096-1 | NY |
NPI | 1003974106 |
---|---|
Provider Name | Dr. Joseph S Rosenberg |
First Address | Bethpage, NY 11714-5713 |
Second Address | Bethpage, NY 11714-5713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00351799 | (05) | NY |
134096-7 AN | WORKERS COMPENSATION (01) | NY |
A62407 | (02) | NY |
JR03488810 | BLUE CROSS BLUE SHIELD (01) | NY |