Provider Demographics
NPI:1164956439
Name:ROSENBLATT ENTERPRISE GROUP, LLC.
Entity Type:Organization
Organization Name:ROSENBLATT ENTERPRISE GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-732-2207
Mailing Address - Street 1:PO BOX 22421
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29413-2421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 MONTAGU ST
Practice Address - Street 2:STE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-6709
Practice Address - Country:US
Practice Address - Phone:843-732-2207
Practice Address - Fax:725-248-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11111207K00000X
SC930332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty