Provider Demographics
NPI:1710935788
Name:ROSENTHAL, BARRY MARK (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:MARK
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 1:259 FIRST ST
Mailing Address - Street 2:WINTHROP UNIVERSITY HOSPITAL
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-663-2727
Mailing Address - Fax:516-663-8549
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:WINTHROP UNIVERSITY HOSPITAL
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-2727
Practice Address - Fax:516-663-8549
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01124565Medicaid
NY01124565Medicaid
A59941Medicare UPIN