Provider Demographics
NPI:1861647042
Name:KENNETH J ROSENTHAL MD PC
Entity Type:Organization
Organization Name:KENNETH J ROSENTHAL MD PC
Other - Org Name:ROSENTHAL EYE SURGERY AND ROSENTHAL FACIAL PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-466-8989
Mailing Address - Street 1:310 E SHORE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2432
Mailing Address - Country:US
Mailing Address - Phone:516-466-8989
Mailing Address - Fax:516-466-8962
Practice Address - Street 1:310 E SHORE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2432
Practice Address - Country:US
Practice Address - Phone:516-466-8989
Practice Address - Fax:516-466-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138603174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0822100001Medicare NSC
B10907Medicare UPIN
20A721Medicare PIN