Individual provider Active NPI

Randy Rosenberg, MD

  • Neurology Physician
  • Philadelphia, PA
National Provider Identifier
1679510283
Registry record updated Feb 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD016929E Issued in PA
Practice address
3509 N Broad St
Philadelphia, PA 19140-4105
Phone
(215) 707-3040
Fax
(215) 707-8235
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD016929E PA
Neurology Physician 2084N0400X MD016929E PA Primary

Addresses

Primary practice location

3509 N Broad St
Philadelphia, PA 19140-4105

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-3040

Other identifiers 1

IdentifierTypeStateIssuer
01108143MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100225000372 PA Practitioner - Neurology 2567506785 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD016929EPAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan, Inc CurrentSince Mar 10, 2019 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 10, 2019 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients

Locations

515 Pennsylvania Ave
Ft Washington, PA 19034
Phone (215) 641-0700

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

7604 Central Ave
Philadelphia, PA 19111
Phone (215) 745-3400

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

8815 Germantown Ave
Philadelphia, PA 19118
Phone (215) 248-8145

3509 N Broad St
Philadelphia, PA 19140
Phone (215) 707-2433

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423094400000",
    "number": "1679510283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404105",
            "telephone_number": "215-707-3040",
            "fax_number": "215-707-8235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBERG",
        "first_name": "RANDY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2015-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD016929E",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD016929E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01108143",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.