Healthcare Provider Details

I. General information

NPI: 1982065033
Provider Name (Legal Business Name): ITAMAR ROSENBAUM C.PED., CFO, BOCPD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 63RD ST
BROOKLYN NY
11204-3058
US

IV. Provider business mailing address

5314 16TH AVE 73
BROOKLYN NY
11204-1425
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-7700
  • Fax: 718-234-3380
Mailing address:
  • Phone: 718-236-7700
  • Fax: 718-234-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: