Basic Information
Provider Information
NPI: 1609905975
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSENBLUM
FirstName: ROBYN
MiddleName: EVE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 27842
Address2:  
City: NEW YORK
State: NY
PostalCode: 100877842
CountryCode: US
TelephoneNumber: 7186701651
FaxNumber: 5164374167
Practice Location
Address1: 5645 MAIN ST
Address2:  
City: FLUSHING
State: NY
PostalCode: 113555045
CountryCode: US
TelephoneNumber: 7186701800
FaxNumber: 5164374167
Other Information
ProviderEnumerationDate: 03/05/2007
LastUpdateDate: 10/03/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X227385NYY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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