Healthcare Provider Details

I. General information

NPI: 1154345924
Provider Name (Legal Business Name): SEAN DAVID ROSENBLUM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LYDIG AVE
BRONX NY
10462-2106
US

IV. Provider business mailing address

820 LYDIG AVE
BRONX NY
10462-2106
US

V. Phone/Fax

Practice location:
  • Phone: 718-792-5900
  • Fax: 718-931-9324
Mailing address:
  • Phone: 718-792-5900
  • Fax: 718-931-9324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005978
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00278900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: