Provider Demographics
NPI:1982790952
Name:ROSENBERG, GLENN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVISON AVE W
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2114
Mailing Address - Country:US
Mailing Address - Phone:516-596-2273
Mailing Address - Fax:516-596-9606
Practice Address - Street 1:974 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4253
Practice Address - Country:US
Practice Address - Phone:516-596-2273
Practice Address - Fax:516-596-9606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO8173111N00000X
NJ38MC00626600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400066307Medicare PIN