Provider Demographics
NPI:1932198454
Name:ROSENBERG, PAUL RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RONALD
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 FORT WASHINGTON AVENUE
Mailing Address - Street 2:STE 1M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-568-2600
Mailing Address - Fax:212-568-0097
Practice Address - Street 1:130 FORT WASHINGTON AVENUE
Practice Address - Street 2:STE 114
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-568-2600
Practice Address - Fax:212-568-0097
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029241E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009484060004Medicaid
PA0009484060004Medicaid
PAC30128Medicare UPIN