Provider Demographics
NPI:1043284540
Name:ROSENBAUM, JULIE ROTHSTEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ROTHSTEIN
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 CHAPEL ST
Mailing Address - Street 2:ADULT PRIMARY CARE CENTER
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-4044
Mailing Address - Fax:203-789-3007
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:ADULT PRIMARY CARE CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-4044
Practice Address - Fax:203-789-3007
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10712Medicare UPIN