Provider Demographics
NPI:1124008651
Name:ROSENBERG, LARRY SOL (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:SOL
Last Name:ROSENBERG
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 1:798 S ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-2620
Mailing Address - Country:US
Mailing Address - Phone:856-809-9001
Mailing Address - Fax:856-809-9003
Practice Address - Street 1:798 S ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2620
Practice Address - Country:US
Practice Address - Phone:856-809-9001
Practice Address - Fax:856-809-9003
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46475174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE62099Medicare UPIN
NJ102523Medicare PIN
NJ636687Medicare ID - Type Unspecified