Provider Demographics
NPI:1992083885
Name:DAYAN-ROSENMAN, DAVID SAMSON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMSON
Last Name:DAYAN-ROSENMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:495 FLATBUSH AVE # C5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3706
Mailing Address - Country:US
Mailing Address - Phone:833-904-2273
Mailing Address - Fax:720-815-0307
Practice Address - Street 1:495 FLATBUSH AVE # C5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3706
Practice Address - Country:US
Practice Address - Phone:833-904-2273
Practice Address - Fax:720-815-0307
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272914207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04251112Medicaid