Provider Demographics
NPI:1699845347
Name:ROSENTHAL, SHELDON A (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:A
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 87TH ST
Mailing Address - Street 2:APT. 10A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4101
Mailing Address - Country:US
Mailing Address - Phone:212-722-5640
Mailing Address - Fax:718-821-0324
Practice Address - Street 1:359 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4024
Practice Address - Country:US
Practice Address - Phone:718-821-3200
Practice Address - Fax:718-821-0324
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00175273Medicaid
NY589041Medicare ID - Type Unspecified
NY00175273Medicaid