Provider Demographics
NPI:1225170723
Name:ROSENWASSER, EDWIN H (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:H
Last Name:ROSENWASSER
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 1:1325 FRANKLIN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-536-1818
Mailing Address - Fax:516-536-4101
Practice Address - Street 1:1325 FRANKLIN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-536-1818
Practice Address - Fax:516-536-4101
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133452208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00728318Medicaid
NY00728318Medicaid
75A661Medicare PIN
B19195Medicare UPIN