Provider Demographics
NPI:1659399020
Name:ROSENBLUM, WILLIAM I (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:I
Last Name:ROSENBLUM
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 1:200 E END AVE
Mailing Address - Street 2:APT 9I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-7831
Mailing Address - Country:US
Mailing Address - Phone:212-996-1772
Mailing Address - Fax:
Practice Address - Street 1:200 E END AVE
Practice Address - Street 2:APT 9I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-7831
Practice Address - Country:US
Practice Address - Phone:212-996-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020157207ZN0500X
NY087844-1207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6655319Medicaid
220000535Medicare ID - Type Unspecified
VA6655319Medicaid