Healthcare Provider Details

I. General information

NPI: 1457449100
Provider Name (Legal Business Name): ALDO M ROSEMBLAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S SUITE 415
JACKSONVILLE FL
32216-4230
US

IV. Provider business mailing address

3627 UNIVERSITY BLVD S SUITE 415
JACKSONVILLE FL
32216-4230
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-2522
  • Fax: 904-296-8173
Mailing address:
  • Phone: 904-296-2522
  • Fax: 904-296-8173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME107703
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101034243
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: