Provider Demographics
NPI:1861609844
Name:ROSENBLUM, LORI (DO)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5224
Mailing Address - Country:US
Mailing Address - Phone:646-284-3658
Mailing Address - Fax:
Practice Address - Street 1:3839 BELL BLVD
Practice Address - Street 2:SUITE 233
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2067
Practice Address - Country:US
Practice Address - Phone:646-284-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine