Provider Demographics
NPI:1033366059
Name:ROSINBERG, AUDREY (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:ROSINBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 77TH ST
Mailing Address - Street 2:13TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1851
Mailing Address - Country:US
Mailing Address - Phone:212-434-3420
Mailing Address - Fax:212-434-3410
Practice Address - Street 1:130 E 77TH ST
Practice Address - Street 2:13TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1851
Practice Address - Country:US
Practice Address - Phone:212-434-3420
Practice Address - Fax:212-434-3410
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2324422086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03161135Medicaid