Provider Demographics
NPI:1104981877
Name:ROSENBERG, ERIC (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 WOODMERE CT
Mailing Address - Street 2:APT. 1C
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2552
Mailing Address - Country:US
Mailing Address - Phone:516-295-0825
Mailing Address - Fax:516-295-0825
Practice Address - Street 1:821 WOODMERE CT
Practice Address - Street 2:APT. 1C
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2552
Practice Address - Country:US
Practice Address - Phone:516-295-0825
Practice Address - Fax:516-295-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004792-1213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1042323OtherUNITED HEALTH CARE
NY1C6729OtherACS HEALTH PLAN
NY4950990001OtherMEDICARE DME
NY9131217OtherCIGNA HEALTH PLANS
NY01302785Medicaid
NY59872OtherVYTRA HEALTH PLANS
NY6200506OtherGROUP HEALTH INCORPORATED
NYU28380Medicare UPIN
NY01302785Medicaid