Basic Information
| Provider Information | |||||||||
| NPI: | 1295862316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENSTREICH | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WESTCHESTER AVE | ||||||||
| Address2: | SUITE N511 | ||||||||
| City: | RYE BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105731354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144285454 | ||||||||
| FaxNumber: | 9142536900 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WESTCHESTER AVE | ||||||||
| Address2: | SUITE N511 | ||||||||
| City: | RYE BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105731354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144285454 | ||||||||
| FaxNumber: | 9142536900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 02/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 60221923 | NY | Y | Other Service Providers | Specialist |
No ID Information.