| Doctor Name: | RUSSELL ROSENBLATT |
| NPI Number: | 1114217635 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 275856 |
| Business Practice Address: | 177 Fort Washington Ave 6th Floor New York, NY - 10032 |
| Business Phone Number: | 2123056354 |
| Business Fax Number: | |
| Mailing Address: | 630 W 168th St, Box 4 NEW YORK |
| State: | NY |
| Postal Code: | 100323725 |
| Phone Number: | 2123425155 |
| Fax Number: | 2123054885 |
| NPI Enumeration Date: | 04/18/2011 |
| NPI Last Update Date: | 07/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 275856 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |