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NPI Code Detail

MEDICARE: MATTHEW ROSENBOOM

MEDICARE:   MATTHEW  ROSENBOOM
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
1282NC2000XChildren's Hospital020108-1NY

General Provider Information

NPI Number : 1760918064
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW ROSENBOOM
Provider Business Mailing Address
First Line : 22 FINDLEY DR
Second Line :
City : EAST NORTHPORT
State : NY
Zip : 11731-4607
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5 DAKOTA DR
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11042-1107
Country : US
Telephone Number : 718-281-8672
Fax Number : 516-302-8657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2017
Last Update Date : 05/11/2026

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Directions to “ MATTHEW ROSENBOOM ” Practice Location

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