Provider Demographics
NPI:1649376583
Name:ROSENBAUM, AYALA (MD)
Entity type:Individual
Prefix:
First Name:AYALA
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 3RD AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1802
Mailing Address - Country:US
Mailing Address - Phone:212-744-5538
Mailing Address - Fax:212-744-4767
Practice Address - Street 1:1421 THIRD AVE.
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1802
Practice Address - Country:US
Practice Address - Phone:212-744-5538
Practice Address - Fax:212-744-4767
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2225722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY222572OtherLICENSE (MD)
NY770T41Medicare PIN
NY222572OtherLICENSE (MD)