Provider Demographics
NPI:1396928958
Name:MICHAEL ROSENBLUM, DPM
Entity type:Organization
Organization Name:MICHAEL ROSENBLUM, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-628-4599
Mailing Address - Street 1:18-05 HILLERY ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5208
Mailing Address - Country:US
Mailing Address - Phone:201-628-4599
Mailing Address - Fax:201-797-1055
Practice Address - Street 1:18-05 HILLERY ST
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5208
Practice Address - Country:US
Practice Address - Phone:201-628-4599
Practice Address - Fax:201-797-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMDOO2464213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5911020001Medicare NSC