Provider Demographics
NPI:1871552349
Name:ROSENBLUTH, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:ROSENBLUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 1ST ST
Mailing Address - Street 2:STE 301
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2153
Mailing Address - Country:US
Mailing Address - Phone:201-996-5850
Mailing Address - Fax:201-336-8578
Practice Address - Street 1:92 2ND ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2105
Practice Address - Country:US
Practice Address - Phone:201-996-5818
Practice Address - Fax:551-996-0577
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32694207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0574805Medicaid
R0466339Medicare ID - Type Unspecified
D19203Medicare UPIN