Provider Demographics
NPI:1225051923
Name:ROSENBAUM, CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 93RD ST
Mailing Address - Street 2:APT. 16A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-9313
Mailing Address - Country:US
Mailing Address - Phone:212-410-4848
Mailing Address - Fax:212-996-0779
Practice Address - Street 1:1185 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1308
Practice Address - Country:US
Practice Address - Phone:212-410-4848
Practice Address - Fax:212-996-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178996174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01505673Medicaid
NYF79602Medicare UPIN
NY10J791Medicare ID - Type Unspecified