Provider Demographics
NPI:1972835908
Name:ROSENBLUM, MICHAEL ADAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ADAM
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:ADAM
Other - Last Name:ROSENBLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:6 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3214
Mailing Address - Country:US
Mailing Address - Phone:845-357-6147
Mailing Address - Fax:
Practice Address - Street 1:80 RED SCHOOLHOUSE RD
Practice Address - Street 2:226
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-7053
Practice Address - Country:US
Practice Address - Phone:845-371-8602
Practice Address - Fax:845-356-2552
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0403731835G0303X
NJ28RI020468001835G0303X
FLPS253361835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric