Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | P9715 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD464004 | PA |
NPI | 1104110188 |
---|---|
Provider Name | Samuel Rosenblatt |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 11/12/2021 |