Provider Demographics
NPI:1407829096
Name:ROSENBERG, MARK (MSN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-0635
Mailing Address - Country:US
Mailing Address - Phone:856-770-5772
Mailing Address - Fax:856-482-1159
Practice Address - Street 1:42 LAUREL RD E
Practice Address - Street 2:SUITE # 3610
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-482-9000
Practice Address - Fax:856-482-1159
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNC093505002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7720602Medicaid
NJS17999Medicare UPIN
NJ7720602Medicaid