Provider Demographics
NPI:1023069846
Name:ROSENTHAL, JEANNE LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:LORRAINE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5944
Mailing Address - Country:US
Mailing Address - Phone:212-674-2970
Mailing Address - Fax:212-674-4384
Practice Address - Street 1:20 E 9TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5944
Practice Address - Country:US
Practice Address - Phone:212-674-2970
Practice Address - Fax:212-674-4384
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142955207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01046006Medicaid
NY01046006Medicaid
B79900Medicare UPIN