1154416055 NPI number — ELLEN S ROSENBERG LCSW

Table of content: ELLEN S ROSENBERG LCSW (NPI 1154416055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154416055 NPI number — ELLEN S ROSENBERG LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBERG
Provider First Name:
ELLEN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154416055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4072 REMSEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEAFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11783-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-785-1657
Provider Business Mailing Address Fax Number:
516-785-1657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4072 REMSEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEAFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11783-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-785-1657
Provider Business Practice Location Address Fax Number:
516-785-1657
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  004319 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 144963 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N4560 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10496025 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 144963 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com