MEDICARE: MR. MARLON S ROSENBAUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	148912	NY
2	207RC0000X	Cardiovascular Disease Physician	148912	NY
3	207RA0002X	Adult Congenital Heart Disease Physician	148912	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588762678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARLON S ROSENBAUM MD

Provider Business Mailing Address
First Line	:	161 FORT WASHINGTON AVE SUITE 557
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032
Country	:	US
Telephone Number	:	212-305-6936
Fax Number	:	212-305-0490

Provider Business Practice Location Address
First Line	:	161 FORT WASHINGTON AVE SUITE 557
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032
Country	:	US
Telephone Number	:	212-305-6936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/18/2021

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