Provider Demographics
NPI:1992781041
Name:BENNETT ROSENTHAL M.S.,PH.D.,M.D.,P.A.
Entity type:Organization
Organization Name:BENNETT ROSENTHAL M.S.,PH.D.,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PHD,MD
Authorized Official - Phone:407-296-1940
Mailing Address - Street 1:PO BOX 1909
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-1909
Mailing Address - Country:US
Mailing Address - Phone:407-296-1940
Mailing Address - Fax:407-296-1942
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 289
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3498
Practice Address - Country:US
Practice Address - Phone:407-296-1940
Practice Address - Fax:407-296-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376814700Medicaid
FL26248OtherBCBSOFFLA
FL376814700Medicaid