Provider Demographics
NPI:1205301314
Name:ROSENBLUM, CARLYN (MS, RD, CDN, CLC)
Entity type:Individual
Prefix:
First Name:CARLYN
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:MS, RD, CDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W 21ST ST APT 1903
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7008
Mailing Address - Country:US
Mailing Address - Phone:301-775-0625
Mailing Address - Fax:
Practice Address - Street 1:7 W 21ST ST APT 1903
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7008
Practice Address - Country:US
Practice Address - Phone:301-775-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86059542133V00000X
NY009478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered