Provider Demographics
NPI:1205837366
Name:ROZENBLATT, SHAHAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAHAL
Middle Name:
Last Name:ROZENBLATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 KARL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2744
Mailing Address - Country:US
Mailing Address - Phone:631-378-0741
Mailing Address - Fax:631-449-7970
Practice Address - Street 1:50 KARL AVE STE 104
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2744
Practice Address - Country:US
Practice Address - Phone:631-378-0741
Practice Address - Fax:631-449-7970
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016095103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist