Provider Demographics
NPI:1093093734
Name:ROSENBERG, HARRISON LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:LEIGH
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 1:301 BRIDGE PLZ N
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5059
Mailing Address - Country:US
Mailing Address - Phone:201-944-6440
Mailing Address - Fax:
Practice Address - Street 1:301 BRIDGE PLZ N
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5059
Practice Address - Country:US
Practice Address - Phone:201-944-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00632700152W00000X
NYTUV007732152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist