Provider Demographics
NPI:1679541106
Name:ROSENSTOCK, KENNETH SAMUEL (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SAMUEL
Last Name:ROSENSTOCK
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 1:4 BRIDGE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1746
Mailing Address - Country:US
Mailing Address - Phone:732-972-6699
Mailing Address - Fax:732-972-3131
Practice Address - Street 1:4 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1746
Practice Address - Country:US
Practice Address - Phone:732-972-6699
Practice Address - Fax:732-972-3131
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02073213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5233208Medicaid
NJU19042Medicare UPIN
NJ679100Medicare ID - Type Unspecified