Provider Demographics
NPI:1144313206
Name:ROSENBLUM, EDWARD S (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-2415
Mailing Address - Country:US
Mailing Address - Phone:914-900-2957
Mailing Address - Fax:914-332-1116
Practice Address - Street 1:1815 PALMER AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3100
Practice Address - Country:US
Practice Address - Phone:914-834-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0324151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice