Provider Demographics
NPI:1639394976
Name:ROSNER, MARTIN CALVIN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:CALVIN
Last Name:ROSNER
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 1:234 VIVIEN CT
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4615
Mailing Address - Country:US
Mailing Address - Phone:201-262-7749
Mailing Address - Fax:
Practice Address - Street 1:234 VIVIEN CT
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4615
Practice Address - Country:US
Practice Address - Phone:201-262-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01853600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD90412Medicare ID - Type Unspecified