Basic Information
Provider Information
NPI: 1306257746
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSENTHAL
FirstName: AMBER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 55 WATER STREET
Address2: 2ND FLOOR CRED DEPT
City: NEW YORK
State: NY
PostalCode: 100410004
CountryCode: US
TelephoneNumber: 6466802888
FaxNumber: 5165425556
Practice Location
Address1: 215 E 95TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 101284077
CountryCode: US
TelephoneNumber: 2129968000
FaxNumber: 2124233127
Other Information
ProviderEnumerationDate: 05/19/2014
LastUpdateDate: 09/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X683821NYN Nursing Service ProvidersRegistered Nurse 
363LF0000X341917NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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