Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MA077428 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | MA077428 | NJ |
NPI | 1235103870 |
---|---|
Provider Name | Jeffrey Rosenberg |
First Address | Newark, NJ 07189-0001 |
Second Address | Berkeley Heights, NJ 07922-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 08/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
089041AUK | MEDICARE (01) | NJ |
G60491 | (02) | NJ |