Healthcare Provider Details

I. General information

NPI: 1023924263
Provider Name (Legal Business Name): FREDERICK MARC ROSENBLUTH DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 ANDERSON AVE
BRONX NY
10452-5302
US

IV. Provider business mailing address

784 COLUMBUS AVE APT 12D
NEW YORK NY
10025-5905
US

V. Phone/Fax

Practice location:
  • Phone: 646-618-2541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: