Provider Demographics
NPI:1265417562
Name:ROSENBLATT, LAURENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 MYSTIC POINTE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2565
Mailing Address - Country:US
Mailing Address - Phone:914-486-8889
Mailing Address - Fax:
Practice Address - Street 1:3600 MYSTIC POINTE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2565
Practice Address - Country:US
Practice Address - Phone:914-486-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103231H00000X
FLAY65231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
M00251Medicare ID - Type Unspecified