Basic Information
| Provider Information | |||||||||
| NPI: | 1932175445 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSNER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2337 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132202337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157015610 | ||||||||
| FaxNumber: | 3157015608 | ||||||||
| Practice Location | |||||||||
| Address1: | 7785 N STATE ST | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | LOWVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133671229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153765163 | ||||||||
| FaxNumber: | 3153760372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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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 | 208600000X | 153527-1 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01073129 | 05 | NY | MEDICAID | BR1245883 | 01 | NY | DEA | OTHER |