Provider Demographics
NPI:1184774051
Name:JESSE S ROSENTHAL MD PC
Entity type:Organization
Organization Name:JESSE S ROSENTHAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-876-3080
Mailing Address - Street 1:21 EAST 93RD STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-876-3080
Mailing Address - Fax:212-987-4935
Practice Address - Street 1:21 EAST 93RD STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-876-3080
Practice Address - Fax:212-987-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1207512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY694801Medicare ID - Type Unspecified