Provider Demographics
NPI:1578726840
Name:ROSENTHAL, JASON MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:45 GARDINER RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2501
Mailing Address - Country:US
Mailing Address - Phone:631-885-0422
Mailing Address - Fax:
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8408
Practice Address - Country:US
Practice Address - Phone:631-968-3503
Practice Address - Fax:631-968-3716
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY253632208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY253632OtherSTATES MEDICAL LICENSE