Provider Demographics
NPI:1043459589
Name:ROSENBERG, GAY RANDI (PT)
Entity Type:Individual
Prefix:MS
First Name:GAY
Middle Name:RANDI
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 91ST ST APT 64
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1336
Mailing Address - Country:US
Mailing Address - Phone:212-873-5866
Mailing Address - Fax:
Practice Address - Street 1:215 W 91ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1321
Practice Address - Country:US
Practice Address - Phone:212-873-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0069152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics