Provider Demographics
NPI:1962647271
Name:ROSENBLUM, TAMAR (MS-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMAR
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 CAFFREY AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5214
Mailing Address - Country:US
Mailing Address - Phone:917-742-4544
Mailing Address - Fax:
Practice Address - Street 1:1854 CORNAGA AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4304
Practice Address - Country:US
Practice Address - Phone:718-471-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017298-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist