Provider Demographics
NPI:1912917394
Name:TAPPER-ROSENBERG, MARCIA (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:TAPPER-ROSENBERG
Suffix:
Gender:F
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-0367
Mailing Address - Country:US
Mailing Address - Phone:718-273-2540
Mailing Address - Fax:
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 103
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-273-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177241207W00000X
NJ25MA05894200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY176772OtherELDERPLAN
NY205400101/201OtherHEALTHPLUS
NYP2018334OtherOXFORD AND OXFORD LIBERTY
NY1974863OtherUNITED
NYTR7241OtherATLANTIS
NY5830756OtherAETNA PPO
NY01659810Medicaid
NY0499385OtherGHI
NY2C1922OtherPHS AND TOUCHSTONE
NY5881672-002OtherCIGNA
NY92H422OtherEMPIRE PPO AND HMO
NY2186510OtherAETNA HMO
NY5830756OtherAETNA PPO