Healthcare Provider Details

I. General information

NPI: 1992951511
Provider Name (Legal Business Name): SIDNEY ROSENBLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 E WALTANN LN
SCOTTSDALE AZ
85254-2002
US

IV. Provider business mailing address

6428 E WALTANN LN
SCOTTSDALE AZ
85254-2002
US

V. Phone/Fax

Practice location:
  • Phone: 480-292-7550
  • Fax:
Mailing address:
  • Phone: 480-292-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number37379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: