Provider Demographics
NPI:1710987912
Name:ROSENBLUM, MICHELE (AUD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HUNGRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2537
Mailing Address - Country:US
Mailing Address - Phone:516-791-8327
Mailing Address - Fax:
Practice Address - Street 1:121 HUNGRY HARBOR RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2537
Practice Address - Country:US
Practice Address - Phone:516-791-8327
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000668231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM72121Medicare ID - Type UnspecifiedAUDIOLOGIST