Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 081655 | NY |
NPI | 1225015019 |
---|---|
Provider Name | Herman Rosenberg |
First Address | Brooklyn, NY 11219 |
Second Address | Brooklyn, NY 11219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 05/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00118649 | (05) | NY |
D38065 | (02) |