Provider Demographics
NPI:1780178798
Name:ROSENBERG, GAIL (PA)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:15 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2603
Mailing Address - Country:US
Mailing Address - Phone:516-510-1630
Mailing Address - Fax:
Practice Address - Street 1:271 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-2135
Practice Address - Country:US
Practice Address - Phone:516-371-9600
Practice Address - Fax:516-371-6083
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021501363A00000X
NY021501-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant