Provider Demographics
NPI:1407909112
Name:ROSENTHAL, LILLIE MICHELE (DO)
Entity Type:Individual
Prefix:DR
First Name:LILLIE
Middle Name:MICHELE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 57TH ST STE 829
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10107-0817
Mailing Address - Country:US
Mailing Address - Phone:212-459-1447
Mailing Address - Fax:212-459-1953
Practice Address - Street 1:250 W 57TH ST STE 829
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107-0817
Practice Address - Country:US
Practice Address - Phone:212-459-1447
Practice Address - Fax:212-459-1953
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210043204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY210043OtherNYS LICENSE