MEDICARE: D JACOB ROSENBAUM MD PC

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
1	207W00000X	Ophthalmology Physician	133543-1	NY

General Provider Information

NPI Number	:	1679013577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D JACOB ROSENBAUM MD PC

Provider Business Mailing Address
First Line	:	1310 48TH ST
Second Line	:	SUITE 207
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3153
Country	:	US
Telephone Number	:	718-436-8988
Fax Number	:	718-435-8861

Provider Business Practice Location Address
First Line	:	1310 48TH ST
Second Line	:	SUITE 207
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3153
Country	:	US
Telephone Number	:	718-436-8988
Fax Number	:	718-435-8861

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIONYS J ROSENBAUM
Credential	:	M.D.
Telephone Number	:	718-436-8988

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/28/2017

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