Provider Demographics
NPI:1215990858
Name:ROSENTHAL, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:ROSENTHAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1777 HAMBURG TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5211
Mailing Address - Country:US
Mailing Address - Phone:973-831-7458
Mailing Address - Fax:973-831-7585
Practice Address - Street 1:1777 HAMBURG TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5211
Practice Address - Country:US
Practice Address - Phone:973-831-7458
Practice Address - Fax:973-831-7585
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-09-11
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Provider Licenses
StateLicense IDTaxonomies
NJ58905207RC0000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7726805Medicaid
NJ7726805Medicaid
NJ473431MDJMedicare PIN