Healthcare Provider Details

I. General information

NPI: 1629645452
Provider Name (Legal Business Name): SAMANTHA ROSENBLATT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BLOOMFIELD AVE
MONTCLAIR NJ
07042-4888
US

IV. Provider business mailing address

15 BLOOMFIELD AVE
MONTCLAIR NJ
07042-4888
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-2770
  • Fax: 973-566-1766
Mailing address:
  • Phone: 973-744-2770
  • Fax: 973-566-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01978600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: