Provider Demographics
NPI:1164422895
Name:ROSENBLATT, MARC J (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 HAVERSTRAW RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2200
Mailing Address - Country:US
Mailing Address - Phone:845-825-6383
Mailing Address - Fax:845-354-4808
Practice Address - Street 1:873 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1905
Practice Address - Country:US
Practice Address - Phone:845-521-1542
Practice Address - Fax:845-354-3808
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1487972081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01453112Medicaid
FL101432500Medicaid
NY74Z051Medicare PIN
NYD60683Medicare UPIN