Provider Demographics
NPI:1063406486
Name:ROZENBERG, ALEKSANDR V (MD)
Entity type:Individual
Prefix:DR
First Name:ALEKSANDR
Middle Name:V
Last Name:ROZENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BURNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1935
Mailing Address - Country:US
Mailing Address - Phone:917-697-7817
Mailing Address - Fax:516-625-4974
Practice Address - Street 1:40 W BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4902
Practice Address - Country:US
Practice Address - Phone:718-627-8300
Practice Address - Fax:718-627-8302
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232855-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02581657Medicaid
NY1063406486OtherNPI
NY9L165ANH21OtherPTAN
NYARO9L16510OtherMEDICARE PROVIDR
NY02581657Medicaid