Provider Demographics
NPI:1295776458
Name:ROSENZWEIG, TODD ALAN (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
Last Name:ROSENZWEIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9921 NW 60TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2558
Mailing Address - Country:US
Mailing Address - Phone:954-612-2032
Mailing Address - Fax:954-755-8648
Practice Address - Street 1:50 EAST SAMPLE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3550
Practice Address - Country:US
Practice Address - Phone:954-942-3991
Practice Address - Fax:954-941-4594
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME828552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263574700Medicaid
H17216Medicare UPIN