Provider Demographics
NPI:1982065033
Name:ROSENBAUM, ITAMAR (CPED, CFO, BOCPD)
Entity Type:Individual
Prefix:
First Name:ITAMAR
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:CPED, CFO, BOCPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 16TH AVE
Mailing Address - Street 2:73
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1425
Mailing Address - Country:US
Mailing Address - Phone:718-236-7700
Mailing Address - Fax:718-234-3380
Practice Address - Street 1:2102 63RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3058
Practice Address - Country:US
Practice Address - Phone:718-236-7700
Practice Address - Fax:718-234-3380
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter