Provider Demographics
NPI:1235248311
Name:ROSENBAUM, DIONYS JACOB (MD)
Entity Type:Individual
Prefix:
First Name:DIONYS
Middle Name:JACOB
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:DIONYS
Other - Last Name:ROSENBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1310 48TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3153
Mailing Address - Country:US
Mailing Address - Phone:718-436-8988
Mailing Address - Fax:718-435-8861
Practice Address - Street 1:1310 48TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3153
Practice Address - Country:US
Practice Address - Phone:718-436-8988
Practice Address - Fax:718-435-8861
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1335431207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279694Medicaid
C08800Medicare UPIN
NY34071Medicare PIN