Provider Demographics
NPI:1598750853
Name:ROSENBLUM, JUDITH BARBARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:BARBARA
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 BIRCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1239
Mailing Address - Country:US
Mailing Address - Phone:516-383-1415
Mailing Address - Fax:631-846-7925
Practice Address - Street 1:627 BROADWAY STE 200
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5031
Practice Address - Country:US
Practice Address - Phone:516-409-8495
Practice Address - Fax:631-846-7925
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010871103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV95142Medicare ID - Type UnspecifiedMEDICARE FOR MASSAPEQUA
NYV95141Medicare ID - Type UnspecifiedMEDICARE FOR DEER PARK