Provider Demographics
NPI:1376828293
Name:ROSENBLUM, IDIT (PT)
Entity Type:Individual
Prefix:
First Name:IDIT
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 KNIGHTSBRIDGE RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4523
Mailing Address - Country:US
Mailing Address - Phone:646-496-5312
Mailing Address - Fax:
Practice Address - Street 1:38 KNIGHTSBRIDGE RD APT 3A
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4523
Practice Address - Country:US
Practice Address - Phone:646-496-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist