Healthcare Provider Details

I. General information

NPI: 1427161710
Provider Name (Legal Business Name): BRETT J ROSENBLATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD SUITE 216
GREAT NECK NY
11021
US

IV. Provider business mailing address

600 NORTHERN BLVD SUITE 216
GREAT NECK NY
11021
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-0390
  • Fax: 516-829-0520
Mailing address:
  • Phone: 516-466-0390
  • Fax: 516-829-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number231148
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: