Provider Demographics
NPI:1982678058
Name:ROSENHEIN, BRIAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:ROSENHEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1253
Mailing Address - Country:US
Mailing Address - Phone:203-709-8873
Mailing Address - Fax:203-709-8689
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1253
Practice Address - Country:US
Practice Address - Phone:203-709-6000
Practice Address - Fax:203-709-3679
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001005017Medicaid
CT5296284OtherAETNA
CT355258OtherWELLCARE
CT0661243OtherCOVENTRY
CT501000OtherCONNECTICARE
CTPENDINGOtherRR MEDICARE
CT0661243OtherCOVENTRY
CT355258OtherWELLCARE