Provider Demographics
NPI:1770658502
Name:ROSENBERG, VICTOR I (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:I
Last Name:ROSENBERG
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 1:4 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3056
Mailing Address - Country:US
Mailing Address - Phone:212-832-9095
Mailing Address - Fax:212-753-7091
Practice Address - Street 1:4 SUTTON PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3056
Practice Address - Country:US
Practice Address - Phone:212-832-9095
Practice Address - Fax:212-753-7091
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY517631Medicare ID - Type Unspecified