Provider Demographics
NPI:1881604593
Name:SUZANNE SIROTA ROZENBERG DO,PC
Entity type:Organization
Organization Name:SUZANNE SIROTA ROZENBERG DO,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:JANICE
Authorized Official - Last Name:SIROTA ROZENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-295-5570
Mailing Address - Street 1:11 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1256
Mailing Address - Country:US
Mailing Address - Phone:516-295-5570
Mailing Address - Fax:
Practice Address - Street 1:11 IRVING PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1256
Practice Address - Country:US
Practice Address - Phone:516-295-5570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180480207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWJW631Medicare PIN
NY08L551Medicare ID - Type Unspecified