Provider Demographics
NPI:1689813016
Name:ROSENBAUM, SIEGFRIED (MD)
Entity Type:Individual
Prefix:DR
First Name:SIEGFRIED
Middle Name:
Last Name:ROSENBAUM
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 1:22 PINE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1516
Mailing Address - Country:US
Mailing Address - Phone:516-367-3516
Mailing Address - Fax:516-224-4092
Practice Address - Street 1:22 PINE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1516
Practice Address - Country:US
Practice Address - Phone:516-367-3516
Practice Address - Fax:516-224-4092
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109435-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12489Medicare UPIN