Provider Demographics
NPI:1841467206
Name:ROSENBLATT, ELISE C (MAC)
Entity type:Individual
Prefix:MS
First Name:ELISE
Middle Name:C
Last Name:ROSENBLATT
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:MS
Other - First Name:ELISE
Other - Middle Name:C
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAC
Mailing Address - Street 1:508 E SEDGWICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1326
Mailing Address - Country:US
Mailing Address - Phone:215-266-5757
Mailing Address - Fax:
Practice Address - Street 1:508 E SEDGWICK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1326
Practice Address - Country:US
Practice Address - Phone:215-266-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000761171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist