Provider Demographics
NPI:1780653998
Name:ROSENBERG, BARRY
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NORTH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1631
Mailing Address - Country:US
Mailing Address - Phone:585-267-7510
Mailing Address - Fax:585-267-7511
Practice Address - Street 1:127 NORTH ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1631
Practice Address - Country:US
Practice Address - Phone:585-344-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2150932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026344402OtherUNIVERA
NY040608000051OtherFIDELIS
NYP010215093OtherROCHESTER BLUE CHOICE
NY2150936BOtherWORKERS COMPENSATION
P00137247OtherRAILROAD MEDICARE
NY02000264Medicaid
NY103432FFOtherPREFERRED CARE
P020215093OtherROCHESTER BLUE SHIELD
000916872003OtherBLUE SHIELD OF WESTERN NY
NY1691700OtherINDEPENDENT HEALTH
NY00026344402OtherUNIVERA
P00137247OtherRAILROAD MEDICARE
NY1691700OtherINDEPENDENT HEALTH