Individual provider Active NPI

Jacob Rosenberg, OD

  • Optometrist
  • Bronx, NY
National Provider Identifier
1033895743
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV009828 Issued in NY
Practice address
1650 Selwyn Ave Apt 1C
Bronx, NY 10457-7628
Phone
(718) 590-1800
NPI assigned
Jun 26, 2023
Last updated
Jun 26, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV009828 NY Primary

Addresses

Primary practice location

1650 Selwyn Ave Apt 1C
Bronx, NY 10457-7628

Mailing address

4004 34TH Ave Apt 409
Long Island City, NY 11101-8542
Phone (518) 727-8125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240904003666 NY Practitioner - Optometry 4082154141 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

3400 Bainbridge Ave
Bronx, NY 10467-2404
Phone (914) 378-6148

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TUV009828NYMDOptometrist
009828NYMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jul 1, 2024 Accepting new patients
Montefiore Medical Center CurrentSince Jul 1, 2024 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1250 Waters Pl
Bronx, NY 10461
Phone (718) 409-9444

1650 Selwyn Ave
Apt 1C
Bronx, NY 10457
Phone (718) 518-5300

2300 Westchester Ave
Bronx, NY 10462
Phone (718) 409-8000

3199 Bainbridge Ave
Bronx, NY 10467
Phone (347) 346-8330

3332 Rochambeau Ave
Bronx, NY 10467
Phone (718) 920-5520

Interoperability endpoints

  • Direct secure messaging: jarosenber@montefioredirect.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1033895743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 34TH AVE APT 409",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111018542",
            "telephone_number": "518-727-8125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 SELWYN AVE APT 1C",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577628",
            "telephone_number": "718-590-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBERG",
        "first_name": "JACOB",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV009828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.