Provider Demographics
NPI:1659356657
Name:ROSENTHAL, STUART A (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:A
Last Name:ROSENTHAL
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 1:171 RAMAPO RD
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923
Mailing Address - Country:US
Mailing Address - Phone:845-947-2240
Mailing Address - Fax:845-947-2265
Practice Address - Street 1:171 RAMAPO RD
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923
Practice Address - Country:US
Practice Address - Phone:845-947-2240
Practice Address - Fax:845-947-2265
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090757207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00144078Medicaid
B79773Medicare UPIN
NY00144078Medicaid
NY905352Medicare PIN