Provider Demographics
NPI:1003004466
Name:JERROLD N ROSENBERG.MD INC
Entity Type:Organization
Organization Name:JERROLD N ROSENBERG.MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-453-5030
Mailing Address - Street 1:827 N MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5751
Mailing Address - Country:US
Mailing Address - Phone:401-453-5030
Mailing Address - Fax:401-453-5033
Practice Address - Street 1:827 N MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5751
Practice Address - Country:US
Practice Address - Phone:401-453-5030
Practice Address - Fax:401-453-5033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERROLD N ROSENBERG.MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-11
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI07222208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI258001134Medicare PIN