Provider Demographics
NPI:1437238011
Name:ROSENBLATT, JEFFREY R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552
Mailing Address - Country:US
Mailing Address - Phone:516-292-0023
Mailing Address - Fax:516-292-3267
Practice Address - Street 1:543 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552
Practice Address - Country:US
Practice Address - Phone:516-292-0023
Practice Address - Fax:516-292-3267
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004355213E00000X
FLPO2818213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1052968OtherGHI
NY01067027Medicaid
PS5731Medicare ID - Type Unspecified
NYJ400051853Medicare PIN
NY1052968OtherGHI
NYA400035371Medicare PIN
T51460Medicare UPIN