Provider Demographics
NPI:1952392466
Name:ROSENBLATT, MARC A
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E 72ND ST
Mailing Address - Street 2:1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4245
Mailing Address - Country:US
Mailing Address - Phone:212-472-8546
Mailing Address - Fax:212-249-2233
Practice Address - Street 1:114 E 72ND ST
Practice Address - Street 2:1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4245
Practice Address - Country:US
Practice Address - Phone:212-472-8546
Practice Address - Fax:212-249-2233
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154949207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05899GOtherGHI-MEDICARE
NY01036837Medicaid
NY05899GOtherGHI-MEDICARE
NY74D381Medicare PIN
A64089Medicare UPIN
NYWEQ011Medicare PIN