Provider Demographics
NPI:1619988086
Name:ROSENDORFF, CLIVE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CLIVE
Middle Name:
Last Name:ROSENDORFF
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CENTRAL PARK W
Mailing Address - Street 2:APARTMENT 83
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7145
Mailing Address - Country:US
Mailing Address - Phone:212-865-3674
Mailing Address - Fax:718-741-4292
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:MEDICINE (111) , JJP VAMC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-741-4292
Practice Address - Fax:718-741-4233
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186625-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02516172Medicaid
NYH16065Medicare UPIN
NY02516172Medicaid