Provider Demographics
NPI:1043245103
Name:ROSENBERG, THEODORE JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOSEPH
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4445
Mailing Address - Country:US
Mailing Address - Phone:215-321-0491
Mailing Address - Fax:215-321-0491
Practice Address - Street 1:315 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1700
Practice Address - Country:US
Practice Address - Phone:908-788-5777
Practice Address - Fax:908-788-6748
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00373100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02090Medicare UPIN
NJ480826C2WMedicare PIN