Provider Demographics
NPI:1588703425
Name:ROSENTHAL, DIANE N (PA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:N
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 STATE ROUTE 33
Mailing Address - Street 2:ACKERMAN 4 TRAUMA
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4859
Mailing Address - Country:US
Mailing Address - Phone:732-776-4949
Mailing Address - Fax:732-776-4843
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:ACKERMAN 4 TRAUMA
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-4949
Practice Address - Fax:732-776-4843
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NJ25MP00122500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00122500OtherSTATE OF NJ LICENSE