Basic Information
| Provider Information | |||||||||
| NPI: | 1528249240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT ROSENZWEIG M D P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6565 SPRING BROOK AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125723726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458763003 | ||||||||
| FaxNumber: | 8454831232 | ||||||||
| Practice Location | |||||||||
| Address1: | 6511 SPRING BROOK AVE | ||||||||
| Address2: | |||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125723709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458764432 | ||||||||
| FaxNumber: | 8458769086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2007 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROSENZWEIG | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8454831230 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 172383 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 01246762 | 05 | NY | MEDICAID |