Provider Demographics
NPI:1689852865
Name:ROSENBERG PLASTIC SURGERY, P.C.
Entity Type:Organization
Organization Name:ROSENBERG PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-213-1974
Mailing Address - Street 1:1820 S BEVERLY GLEN BLVD
Mailing Address - Street 2:#205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6927
Mailing Address - Country:US
Mailing Address - Phone:312-213-1974
Mailing Address - Fax:310-278-0098
Practice Address - Street 1:1820 S BEVERLY GLEN BLVD
Practice Address - Street 2:#205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6927
Practice Address - Country:US
Practice Address - Phone:312-213-1974
Practice Address - Fax:310-278-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92453208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116703Medicare PIN
CAW22458Medicare PIN