Provider Demographics
NPI:1801043211
Name:ROSENBAUM, RAPHAEL ELIEZER (MD)
Entity type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:ELIEZER
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 EAST 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0306
Mailing Address - Country:US
Mailing Address - Phone:212-772-0600
Mailing Address - Fax:212-517-8028
Practice Address - Street 1:1316 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3167
Practice Address - Country:US
Practice Address - Phone:718-436-8988
Practice Address - Fax:718-435-8861
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257453207W00000X, 207WX0108X
NY257453-1207W00000X
MA239531207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032639003Medicaid