Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 091087 | NY |
NPI | 1235467044 |
---|---|
Provider Name | Dr. Martin B. Rosenblum |
First Address | Woodbury, NY 11797-2914 |
Second Address | Woodbury, NY 11797-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2009 |
Last Update Date | 28/05/2010 |