Provider Demographics
NPI:1578660932
Name:ROSENBAUM, EDWARD ABRAHAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ABRAHAM
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 ROUTE 10, SUITE 5
Mailing Address - Street 2:RANDOLPH CENTER FOR ORAL & MAXILLOFACIAL SURGERY
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-328-1555
Mailing Address - Fax:973-328-3405
Practice Address - Street 1:447 ROUTE 10, SUITE 5
Practice Address - Street 2:RANDOLPH CENTER FOR ORAL & MAXILLOFACIAL SURGERY
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-328-1555
Practice Address - Fax:973-328-3405
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018357001223S0112X
NY04474311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001357MKVMedicare ID - Type Unspecified
NYU67745Medicare UPIN
NJU67745Medicare UPIN