Provider Demographics
NPI:1700126349
Name:SCOTT L. ROSENZWEIG M.D. INC.
Entity Type:Organization
Organization Name:SCOTT L. ROSENZWEIG M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:ROSENZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-315-1786
Mailing Address - Street 1:528 PALISADES DR
Mailing Address - Street 2:#516
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2844
Mailing Address - Country:US
Mailing Address - Phone:310-315-1786
Mailing Address - Fax:310-393-7230
Practice Address - Street 1:1450 10TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2857
Practice Address - Country:US
Practice Address - Phone:310-315-1786
Practice Address - Fax:310-393-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81286207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty