Provider Demographics
NPI:1073515706
Name:ROSENBAUM, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:218C SUNSET RD
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1104
Practice Address - Country:US
Practice Address - Phone:609-877-0400
Practice Address - Fax:609-877-1682
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05762800207R00000X, 207RE0101X
PAMD039869E207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3K6070OtherHEALTHNET, INC
NJ0690949OtherCIGNA
NJ18916OtherUNIVERISTY HEALTH PLAN
NJ5148600Medicaid
NJ011632OtherAMERIHEALTH PPO
NJ0191698000OtherAMERICHOICE
NJP00212201OtherRR MEDICARE
NJP3597670OtherOXFORD
NJ1542377OtherUNITED HEALTHCARE
NJ3818494OtherAETNA
NJ0191698000OtherAMERICHOICE
NJ0690949OtherCIGNA
NJP3597670OtherOXFORD