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General NPI Number Information
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NPI Number | 1740707652
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Entity Type | Individual
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Provider Name | MORTON ROSENBAUM PHD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | CITPD AT MOUNT SINAI WEST PSYCHIATRY DEPARTMENT 1000 TENTH AVENUE
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City | NEW YORK
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State | NY
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Zip | 10019
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Country | US
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Telephone | 212-523-6983
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 DORCHESTER RD APT 3B
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City | BROOKLYN
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State | NY
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Zip | 11226-5766
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Country | US
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Telephone | 917-699-5879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 022297
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License Number State | NY
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