Provider Demographics
NPI:1952310245
Name:ROSENSTEIN, CHARLES CORY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CORY
Last Name:ROSENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:CORY
Other - Last Name:ROSENSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:29 HOSPITAL PLAZA
Mailing Address - Street 2:SUITE 602
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-276-4884
Mailing Address - Fax:203-276-8418
Practice Address - Street 1:29 HOSPITAL PLAZA
Practice Address - Street 2:SUITE 602
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-4884
Practice Address - Fax:203-276-8418
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT31582207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT31582Medicare UPIN
CT31582Medicare UPIN
CT140000120Medicare ID - Type Unspecified