Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 058245 | NY |
NPI | 1063835759 |
---|---|
Provider Name | Dr. Gila Rosenbaum |
First Address | Bronx, NY 10463-3229 |
Second Address | Bronx, NY 10463-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2014 |
Last Update Date | 18/09/2019 |