Provider Demographics
NPI:1467485268
Name:ROSENBAUM, ERIC J (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:JOHN
Other - Last Name:ROSENBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1200 MOUNT KEMBLE AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-8008
Mailing Address - Country:US
Mailing Address - Phone:973-993-4445
Mailing Address - Fax:973-993-4942
Practice Address - Street 1:1200 MOUNT KEMBLE AVE STE 350
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8008
Practice Address - Country:US
Practice Address - Phone:973-993-4445
Practice Address - Fax:973-993-4942
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221883202D00000X
HIMD-23386-0202D00000X
NJ25MA07439100202D00000X
CAC185346202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02209841Medicaid
NY02209841Medicaid
NY2I2551Medicare PIN