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General NPI Number Information
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NPI Number | 1912285156
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Entity Type | Individual
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Provider Name | MARISA ROZENBLAT FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 85 WEST BURNSIDE AVE
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City | BRONX
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State | NY
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Zip | 10453
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Country | US
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Telephone | 718-584-4683
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Fax |
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Provider Business Mailing Address
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Address Line | 85 W BURNSIDE AVE
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City | BRONX
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State | NY
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Zip | 10453-4015
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Country | US
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Telephone | 718-584-4683
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 336648
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License Number State | NY
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