Provider Demographics
NPI:1902119209
Name:ROSENBERG, LAURA (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 BEACH 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4810
Mailing Address - Country:US
Mailing Address - Phone:347-342-0263
Mailing Address - Fax:
Practice Address - Street 1:445 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2001
Practice Address - Country:US
Practice Address - Phone:516-374-3377
Practice Address - Fax:516-374-3310
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030934172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker