Provider Demographics
NPI:1700834652
Name:ROSENBLUM, MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18-05 HILLERY ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5208
Mailing Address - Country:US
Mailing Address - Phone:201-773-8686
Mailing Address - Fax:201-773-8683
Practice Address - Street 1:14-25 PLAZA RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3546
Practice Address - Country:US
Practice Address - Phone:201-773-8686
Practice Address - Fax:201-773-8683
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002464213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7928301Medicaid
NJ7928301Medicaid
NJ027218Medicare ID - Type Unspecified