Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 27903 | GA |
NPI | 1013972074 |
---|---|
Provider Name | Dr. Jeffrey Steven Rosenblatt |
First Address | Dacula, GA 30019-4639 |
Second Address | Atlanta, GA 30342-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D41007 | (02) |