Provider Demographics
NPI:1437261385
Name:ROSENBAUM, GARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:887 OLD COUNTRY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2115
Mailing Address - Country:US
Mailing Address - Phone:631-727-6122
Mailing Address - Fax:631-727-2672
Practice Address - Street 1:887 OLD COUNTRY RD
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2115
Practice Address - Country:US
Practice Address - Phone:631-727-6122
Practice Address - Fax:631-727-2672
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY173542207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01192429Medicaid
NYE44787Medicare UPIN
NY41F522Medicare ID - Type Unspecified