Provider Demographics
NPI:1841575651
Name:ROSENBERG, STUART THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:THEODORE
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 1:278 ROOSEVELT WAY
Mailing Address - Street 2:BUILDING 18
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-385-5187
Mailing Address - Fax:516-385-5187
Practice Address - Street 1:278 ROOSEVELT WAY
Practice Address - Street 2:BUILDING 18
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-385-5187
Practice Address - Fax:516-385-5187
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist