Provider Demographics
NPI:1609804848
Name:ROSENBERG, JAY H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
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 1:9505 HILLWOOD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0514
Mailing Address - Country:US
Mailing Address - Phone:619-884-9170
Mailing Address - Fax:855-927-7788
Practice Address - Street 1:9505 HILLWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0514
Practice Address - Country:US
Practice Address - Phone:619-884-9170
Practice Address - Fax:855-927-7788
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG170592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG17059Medicare UPIN
CAWG17059FMedicare ID - Type Unspecified
CAWG17059EMedicare ID - Type Unspecified
CAWG17059IMedicare ID - Type Unspecified
CAG17059Medicare UPIN
CAWG17059DMedicare ID - Type Unspecified
CAWG17059HMedicare ID - Type Unspecified