Provider Demographics
NPI:1457337503
Name:ROSENTHAL, BENNETT M (MS PHD MD PA)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:M
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MS PHD MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1909
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-1909
Mailing Address - Country:US
Mailing Address - Phone:407-296-1940
Mailing Address - Fax:407-296-1942
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 289
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3498
Practice Address - Country:US
Practice Address - Phone:407-296-1940
Practice Address - Fax:407-296-1942
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME670512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF10755Medicare UPIN
FL26248Medicare PIN