Basic Information
| Provider Information | |||||||||
| NPI: | 1558329748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSENBLUM | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | Z | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7247-6822 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191700001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Practice Location | |||||||||
| Address1: | 1561 RTE 9W | ||||||||
| Address2: | |||||||||
| City: | LAKE KATRINE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124495410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452315600 | ||||||||
| FaxNumber: | 8452315489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 121300 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00502016 | 05 | NY | MEDICAID |