Provider Demographics
NPI:1467667097
Name:MARVIN S. ROSENBLATT, PH.D., P.A.
Entity Type:Organization
Organization Name:MARVIN S. ROSENBLATT, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-722-2020
Mailing Address - Street 1:6203 WEST COMMERCIAL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FT.LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-722-2020
Mailing Address - Fax:
Practice Address - Street 1:6203 WEST COMMERCIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:FT.LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-722-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75781OtherBLUE CROSS BLUE SHIELD ID
FL75781Medicare ID - Type Unspecified