Provider Demographics
NPI:1578596391
Name:ROSENBERG, CRAIG H (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:H
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 1:17 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1026
Mailing Address - Country:US
Mailing Address - Phone:516-630-3525
Mailing Address - Fax:888-279-5444
Practice Address - Street 1:70 GLEN ST
Practice Address - Street 2:STE 101
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2853
Practice Address - Country:US
Practice Address - Phone:516-630-3525
Practice Address - Fax:888-279-5444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153525208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63472Medicare UPIN