Provider Demographics
NPI:1932187648
Name:ROSENBERG, IRENE ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ELAINE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:ROSENBERG
Other - Last Name:NATOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:949 CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-295-1921
Mailing Address - Fax:516-295-9304
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-295-1921
Practice Address - Fax:516-295-9304
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154948207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIR084D1810OtherBLUE CROSS
A64476Medicare UPIN
NY84D1819181Medicare PIN