Provider Demographics
NPI:1114081916
Name:ROSENTHAL, MARGOT E (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:E
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BOX PL
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-1620
Mailing Address - Country:US
Mailing Address - Phone:631-974-4471
Mailing Address - Fax:
Practice Address - Street 1:1 BOX PL
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-1620
Practice Address - Country:US
Practice Address - Phone:631-974-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4024862084P0805X
NY000470367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038Medicare ID - Type UnspecifiedGROUP #
NYA400053319Medicare PIN