Provider Demographics
NPI:1316928187
Name:ROSENKILDE, CARL E (MD PHD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:ROSENKILDE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2810
Mailing Address - Country:US
Mailing Address - Phone:914-241-1717
Mailing Address - Fax:914-241-0413
Practice Address - Street 1:91 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2810
Practice Address - Country:US
Practice Address - Phone:914-241-1717
Practice Address - Fax:914-241-0413
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177237-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01145239Medicaid
WS222OtherOXFORD
NY92Z02WS371OtherRAILROAD MEDICARE
WS222OtherOXFORD
NY92Z02WS371OtherRAILROAD MEDICARE