Basic Information
| Provider Information | |||||||||
| NPI: | 1710987169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENTHAL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2095 FLATBUSH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112344338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183386868 | ||||||||
| FaxNumber: | 7183386868 | ||||||||
| Practice Location | |||||||||
| Address1: | 2095 FLATBUSH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112344338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183386868 | ||||||||
| FaxNumber: | 7183386868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 02/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 153961 | NY | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 2085R0202X | 153961-2 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 01348109 | 05 | NY | MEDICAID | 300025377 | 01 | NY | RAILROAD MEDICARE | OTHER |