Provider Demographics
NPI:1609130996
Name:ROSENBLOOM, DANA JILL (MS ED)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:JILL
Last Name:ROSENBLOOM
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 81ST ST
Mailing Address - Street 2:APT 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7095
Mailing Address - Country:US
Mailing Address - Phone:516-410-8968
Mailing Address - Fax:
Practice Address - Street 1:520 E 81ST ST
Practice Address - Street 2:APT 5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7095
Practice Address - Country:US
Practice Address - Phone:516-410-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist