Provider Demographics
NPI:1043233901
Name:ROSENBAUM, PEARL (MD)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 ISELIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3321
Mailing Address - Country:US
Mailing Address - Phone:203-246-2632
Mailing Address - Fax:203-299-1572
Practice Address - Street 1:3333 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3224
Practice Address - Country:US
Practice Address - Phone:718-548-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1598861207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01088366Medicaid
NY01088366Medicaid
NY27E722Medicare ID - Type Unspecified