Active NPI
Edward M Rosenblatt, MD
- Diagnostic Radiology Physician
- Manchester, CT
National Provider Identifier
1407866544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 029850
- Practice address
- 71 Haynes St
Manchester, CT 06040 - Phone
- (860) 646-1222
- Fax
- (860) 533-3498
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 029850 | CT | Primary |
Addresses
Primary practice location
71 Haynes St
Manchester, CT 06040
Mailing address
341 East Center St
PMB 141
Manchester, CT 06040
Phone (860) 646-1222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1298505 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029850 | CT | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evergreen Imaging Center, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Radiology Clinic/Center
- South Windsor, CT
- NPI 1316050925
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186876800000",
"number": "1407866544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "341 EAST CENTER ST",
"address_2": "PMB 141",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "06040",
"telephone_number": "860-646-1222",
"fax_number": "860-533-3498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 HAYNES ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "06040",
"telephone_number": "860-646-1222",
"fax_number": "860-533-3498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENBLATT",
"first_name": "EDWARD",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2007-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CT",
"license": "029850",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1298505",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.