Provider Demographics
NPI:1063872463
Name:ROSENTHAL, MITCHELL L I (ATC)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:L
Last Name:ROSENTHAL
Suffix:I
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 ROUTE 10 APT D6
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1229
Mailing Address - Country:US
Mailing Address - Phone:973-580-2477
Mailing Address - Fax:
Practice Address - Street 1:2350 ROUTE 10 APT D6
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1229
Practice Address - Country:US
Practice Address - Phone:973-580-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000638002255A2300X
FLAL 23352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer