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General NPI Number Information
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NPI Number | 1861609844
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Entity Type | Individual
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Provider Name | LORI ROSENBLUM D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 3839 BELL BLVD SUITE 233
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City | BAYSIDE
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State | NY
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Zip | 11361-2067
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Country | US
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Telephone | 646-284-3658
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Fax |
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Provider Business Mailing Address
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Address Line | 226 FLORAL AVE
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City | PLAINVIEW
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State | NY
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Zip | 11803-5224
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Country | US
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Telephone | 646-284-3658
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 216139
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License Number State | NY
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