Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 092716 | NY |
NPI | 1023266558 |
---|---|
Provider Name | Robert Rosenbaum |
First Address | Cortlandt Manor, NY 10567-4144 |
Second Address | Cortlandt Manor, NY 10567-4144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2008 |
Last Update Date | 09/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00274153 | (05) | NY |