Provider Demographics
NPI:1750661104
Name:LISA ROSENBERG MD PC
Entity Type:Organization
Organization Name:LISA ROSENBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-454-3200
Mailing Address - Street 1:61-34 188TH ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2726
Mailing Address - Country:US
Mailing Address - Phone:718-454-3200
Mailing Address - Fax:718-454-4191
Practice Address - Street 1:61-34 188TH ST
Practice Address - Street 2:SUITE 214
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2726
Practice Address - Country:US
Practice Address - Phone:718-454-3200
Practice Address - Fax:718-454-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151716207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty