Healthcare Provider Details

I. General information

NPI: 1033238803
Provider Name (Legal Business Name): ELIZABETH ANNE ROSENBAUM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE AVE SUITE LL400
BRONX NY
10467-2404
US

IV. Provider business mailing address

182 2ND ST
CLIFTON NJ
07011-2602
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-5531
  • Fax: 718-652-4018
Mailing address:
  • Phone: 973-650-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN10652500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: