Provider Demographics
NPI: | 1316130875 |
---|---|
Name: | ROSENTHAL, STEVE (DC, LAC, CA) |
Entity type: | Individual |
Prefix: | DR |
First Name: | STEVE |
Middle Name: | |
Last Name: | ROSENTHAL |
Suffix: | |
Gender: | M |
Credentials: | DC, LAC, CA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1005 WASHINGTON BLVD |
Mailing Address - Street 2: | WASHINGTON WELLNESS CENTER |
Mailing Address - City: | ROBBINSVILLE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08691-3119 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 609-426-1700 |
Mailing Address - Fax: | 609-426-0099 |
Practice Address - Street 1: | 1005 WASHINGTON BLVD |
Practice Address - Street 2: | WASHINGTON WELLNESS CENTER |
Practice Address - City: | ROBBINSVILLE |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08691-3119 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-426-1700 |
Practice Address - Fax: | 609-426-0099 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-08-19 |
Last Update Date: | 2011-06-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 002192 | 111N00000X |
NY | 908 | 171100000X |
NJ | 275 | 171100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | |
No | 111N00000X | Chiropractic Providers | Chiropractor |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | C02192-5W | Other | NYS WORKER'S COMP |