Provider Demographics
NPI:1154345924
Name:ROSENBLUM, SEAN DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:DAVID
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 LYDIG AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2106
Mailing Address - Country:US
Mailing Address - Phone:718-792-5900
Mailing Address - Fax:718-931-9324
Practice Address - Street 1:820 LYDIG AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2106
Practice Address - Country:US
Practice Address - Phone:718-792-5900
Practice Address - Fax:718-931-9324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005978213ES0103X
NJ25MD00278900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV04167Medicare UPIN
NJ088816Medicare PIN