Provider Demographics
NPI:1982085130
Name:ROSENBAUM, DIANA GRACE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:GRACE
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MERCER ST
Mailing Address - Street 2:APT #1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4615
Mailing Address - Country:US
Mailing Address - Phone:617-970-3966
Mailing Address - Fax:
Practice Address - Street 1:110 BERGEN ST RM D716
Practice Address - Street 2:PEDIATRIC DENTISTRY DEPARTMENT
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program