Provider Demographics
NPI:1659492023
Name:ROSENBERGER, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ROSENBERGER
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 1:29 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1805
Mailing Address - Country:US
Mailing Address - Phone:518-523-1122
Mailing Address - Fax:518-897-2423
Practice Address - Street 1:29 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1805
Practice Address - Country:US
Practice Address - Phone:518-523-1122
Practice Address - Fax:518-897-2423
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0434801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00363213Medicaid
NY043480OtherNEW YORK STATE LICENSE
NY043480OtherNEW YORK STATE LICENSE