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NPI Code Detail

MEDICARE: SIMON PETER ROSENBLUM ATC

MEDICARE:   SIMON PETER ROSENBLUM  ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer25MT00079200NJ

General Provider Information

NPI Number : 1386804128
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMON PETER ROSENBLUM ATC
Provider Business Mailing Address
First Line : 2448 STEINER RD
Second Line :
City : MANCHESTER
State : NJ
Zip : 08759-6137
Country : US
Telephone Number : 732-674-1405
Fax Number :
Provider Business Practice Location Address
First Line : 400 CEDAR AVE
Second Line :
City : W LONG BRANCH
State : NJ
Zip : 07764-1804
Country : US
Telephone Number : 732-263-5249
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2008
Last Update Date : 06/16/2008

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Directions to “ SIMON PETER ROSENBLUM ATC” Practice Location

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