Provider Demographics
NPI:1558466417
Name:ROSENBLATT, WILLIAM B (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:ROSENBLATT
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 1:308 E 79TH ST
Mailing Address - Street 2:STE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0906
Mailing Address - Country:US
Mailing Address - Phone:212-570-6100
Mailing Address - Fax:212-570-6155
Practice Address - Street 1:308 E 79TH ST
Practice Address - Street 2:STE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0906
Practice Address - Country:US
Practice Address - Phone:212-570-6100
Practice Address - Fax:212-570-6155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120750208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132988344OtherTAX ID
09A561Medicare ID - Type Unspecified
NY132988344OtherTAX ID