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General NPI Number Information
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NPI Number | 1346559192
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Entity Type | Organization
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Legal Business Name | GARY S ROSENBAUM MD PC
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 887 OLD COUNTRY RD SUITE A
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City | RIVERHEAD
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State | NY
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Zip | 11901-2115
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Country | US
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Telephone | 631-727-6122
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Fax | 631-727-2672
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Provider Business Mailing Address
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Address Line | 887 OLD COUNTRY RD SUITE A
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City | RIVERHEAD
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State | NY
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Zip | 11901-2115
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Country | US
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Telephone | 631-727-6122
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Fax | 631-727-2672
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MISS SHARYN DONNELLY
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Credential |
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Telephone | 631-727-6122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 1735421
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License Number State | NY
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