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General NPI Number Information
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NPI Number | 1174042949
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Entity Type | Organization
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Legal Business Name | PAIN, SPINE, AND SPORT MEDICINE, PC
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 09/13/2017
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Provider Practice Location Address
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Address Line | 873 ROUTE 45
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City | NEW CITY
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State | NY
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Zip | 10956-1116
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Country | US
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Telephone | 845-570-5260
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | THIELLS
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State | NY
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Zip | 10984-0489
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC ROSENBLATT
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Credential | MD
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Telephone | 845-570-5260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 148797
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License Number State | NY
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