Provider Demographics
NPI:1659526176
Name:ROSENBLUTH, GARY (LDADC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:ROSENBLUTH
Suffix:
Gender:M
Credentials:LDADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE SEARS DRIVE
Mailing Address - Street 2:3RD FL
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-967-0500
Mailing Address - Fax:201-967-0811
Practice Address - Street 1:ONE SEARS DRIVE
Practice Address - Street 2:3RD FL
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-967-0500
Practice Address - Fax:201-967-0811
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00101200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)