Provider Demographics
NPI:1053495887
Name:ROSENTHAL, BRENT HAYDEN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:HAYDEN
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2554
Mailing Address - Country:US
Mailing Address - Phone:732-577-1222
Mailing Address - Fax:732-577-9821
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2554
Practice Address - Country:US
Practice Address - Phone:732-577-1222
Practice Address - Fax:732-577-9821
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01339213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2231000Medicaid
NJT51400Medicare UPIN
NJ2231000Medicaid