Provider Demographics
NPI:1851466288
Name:ROSENBLUM, HERSCHEL HAROLD (DPM)
Entity type:Individual
Prefix:DR
First Name:HERSCHEL
Middle Name:HAROLD
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 1:800 S CENTRAL AVE
Mailing Address - Street 2:302
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4370
Mailing Address - Country:US
Mailing Address - Phone:818-240-5575
Mailing Address - Fax:818-240-1487
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:302
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-240-5575
Practice Address - Fax:818-240-1487
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1114213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T10774Medicare UPIN
WE4379Medicare PIN