Provider Demographics
NPI:1457449100
Name:ROSEMBLAT, ALDO M (MD)
Entity Type:Individual
Prefix:
First Name:ALDO
Middle Name:M
Last Name:ROSEMBLAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 415
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4230
Mailing Address - Country:US
Mailing Address - Phone:904-296-2522
Mailing Address - Fax:904-296-8173
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 415
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4230
Practice Address - Country:US
Practice Address - Phone:904-296-2522
Practice Address - Fax:904-296-8173
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107703207T00000X
VA0101034243207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003887500Medicaid
VA06109594Medicaid
FL145880Medicare PIN
VA06109594Medicaid
VA192033Medicare PIN