Provider Demographics
NPI:1083751598
Name:BRUCE R. ROSENBLUM, MD PC
Entity Type:Organization
Organization Name:BRUCE R. ROSENBLUM, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-460-1522
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-0159
Mailing Address - Country:US
Mailing Address - Phone:732-460-1522
Mailing Address - Fax:732-460-1529
Practice Address - Street 1:160 AVENUE OF THE CMN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4802
Practice Address - Country:US
Practice Address - Phone:732-460-1522
Practice Address - Fax:732-460-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05714300207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5041007Medicaid
NJ5041007Medicaid
NJ0707819Medicare ID - Type Unspecified