Basic Information
Provider Information | |||||||||
NPI: | 1427054782 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROSENTHAL | ||||||||
FirstName: | CYNTHIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1000 MONTAUK HWY | ||||||||
Address2: |   | ||||||||
City: | WEST ISLIP | ||||||||
State: | NY | ||||||||
PostalCode: | 117954927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6313763000 | ||||||||
FaxNumber: | 6312248560 | ||||||||
Practice Location | |||||||||
Address1: | 1000 MONTAUK HWY | ||||||||
Address2: |   | ||||||||
City: | WEST ISLIP | ||||||||
State: | NY | ||||||||
PostalCode: | 117954927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6313763000 | ||||||||
FaxNumber: | 6312248560 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/22/2005 | ||||||||
LastUpdateDate: | 01/30/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | 195868 | NY | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
ID | Type | State | Issuer | Description | 86952 | 01 | NY | VYTRA HEALTH CARE | OTHER | P1047235 | 01 | NY | OXFORD | OTHER | 01806202 | 05 | NY |   | MEDICAID | 2C2617 | 01 | NY | HEALTHNET | OTHER | 76-86062 | 01 | NY | UHC CHILD HEALTH PLUS | OTHER | 43N221 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 0522690 | 01 | NY | AETNA/US HEALTHCARE | OTHER | 4265641 | 01 | NY | CIGNA | OTHER | 46386 | 01 | NY | MAGNACARE | OTHER | 6101386 | 01 | NY | GHI | OTHER | 040426010670 | 01 | NY | FIDELIS | OTHER | AA50732 | 01 | NY | MDNY | OTHER | 010195868NY01 | 01 | NY | ANTHEM NY | OTHER |