Provider Demographics
NPI:1295750230
Name:ROSENTHAL, KENNETH J (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:310 E SHORE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2432
Mailing Address - Country:US
Mailing Address - Phone:516-466-8989
Mailing Address - Fax:516-466-8962
Practice Address - Street 1:310 E SHORE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2432
Practice Address - Country:US
Practice Address - Phone:516-466-8989
Practice Address - Fax:516-466-8962
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-02-11
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Provider Licenses
StateLicense IDTaxonomies
NY138603207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20A721Medicare PIN
NYB10907Medicare UPIN