Provider Demographics
NPI:1467535120
Name:ROSENFELD, NATHAN SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:SAMUEL
Last Name:ROSENFELD
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 1:110 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5028
Mailing Address - Country:US
Mailing Address - Phone:914-636-4030
Mailing Address - Fax:914-636-4095
Practice Address - Street 1:110 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5028
Practice Address - Country:US
Practice Address - Phone:914-636-4030
Practice Address - Fax:914-636-4095
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143751207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01389028Medicaid
NY01389028Medicaid
NYB14946Medicare UPIN