Provider Demographics
NPI:1083642235
Name:ROSNER, JOEL LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:LOUIS
Last Name:ROSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11003 SW 77TH COURT CIR
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3765
Mailing Address - Country:US
Mailing Address - Phone:305-668-9733
Mailing Address - Fax:
Practice Address - Street 1:4500 BROOKTREE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9289
Practice Address - Country:US
Practice Address - Phone:724-933-6569
Practice Address - Fax:724-933-6536
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4217992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2649665Medicaid
086993TN5Medicare ID - Type Unspecified
H78002Medicare UPIN