Provider Demographics
NPI:1841245859
Name:SIROTA ROZENBERG, SUZANNE JANICE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:JANICE
Last Name:SIROTA ROZENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1256
Mailing Address - Country:US
Mailing Address - Phone:516-295-5570
Mailing Address - Fax:516-295-5575
Practice Address - Street 1:11 IRVING PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1256
Practice Address - Country:US
Practice Address - Phone:516-295-5570
Practice Address - Fax:516-295-5575
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180480207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6514VJMedicare PIN
NY08LL5Medicare ID - Type Unspecified