Provider Demographics
NPI:1669523486
Name:ROSENBAUM, DAVE (PH D)
Entity type:Individual
Prefix:DR
First Name:DAVE
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 MUTTONTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:MUTTONTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-496-9520
Mailing Address - Fax:516-496-9523
Practice Address - Street 1:1906 MUTTONTOWN ROAD
Practice Address - Street 2:
Practice Address - City:MUTTONTOWN
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-496-9520
Practice Address - Fax:516-496-9523
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4825103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist