Provider Demographics
NPI:1699190058
Name:ROSENBAUM, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 WESTCHESTER AVE
Mailing Address - Street 2:SUITE N-230
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3516
Mailing Address - Country:US
Mailing Address - Phone:914-282-1078
Mailing Address - Fax:
Practice Address - Street 1:1133 WESTCHESTER AVE
Practice Address - Street 2:SUITE N230
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3516
Practice Address - Country:US
Practice Address - Phone:914-282-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist