Provider Demographics
NPI:1659502912
Name:ROSENBLUTH, STEPHEN J (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:ROSENBLUTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 204TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2626
Mailing Address - Country:US
Mailing Address - Phone:516-606-8683
Mailing Address - Fax:
Practice Address - Street 1:4205 204TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2626
Practice Address - Country:US
Practice Address - Phone:516-606-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011656-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor