MEDICARE: DR. ALFRED ROSENBAUM M.D.

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	2085R0001X	Radiation Oncology Physician	116442	NY
2	2085R0202X	Diagnostic Radiology Physician	116442	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790881852	OTHER		NPI

General Provider Information

NPI Number	:	1790881852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED ROSENBAUM M.D.

Provider Business Mailing Address
First Line	:	1500 ROUTE 112 BLDG 4
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8055
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-509-6559

Provider Business Practice Location Address
First Line	:	1421 3RD AVE
Second Line	:	FIRST FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10028-1802
Country	:	US
Telephone Number	:	212-744-5538
Fax Number	:	212-744-4767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/31/2020

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