Provider Demographics
NPI:1871791038
Name:ROSENBERG, JASON EMMANUEL (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EMMANUEL
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4451
Mailing Address - Fax:970-490-4199
Practice Address - Street 1:4110 BRIARGATE PKWY STE 100B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7836
Practice Address - Country:US
Practice Address - Phone:719-364-0160
Practice Address - Fax:719-364-0161
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1557-10208100000X
CODR.0067216208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31832521Medicaid
NMP00886032OtherMEDICARE RAILROAD
NMNMA100914Medicare UPIN