Provider Demographics
NPI:1942268073
Name:ROSENBERG, JONATHAN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ERIC
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 1:353 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5606
Mailing Address - Country:US
Mailing Address - Phone:646-422-4461
Mailing Address - Fax:646-227-2417
Practice Address - Street 1:353 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:646-422-4461
Practice Address - Fax:646-227-2417
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71732207R00000X, 207RX0202X
MA235529207R00000X, 207RX0202X
NY212436207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A7173200Medicaid
CA0A7173200Medicaid
CA0A7173200Medicare PIN