Provider Demographics
NPI:1083917454
Name:ROSENBERG, LAURA KAREN (RD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KAREN
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1026
Mailing Address - Country:US
Mailing Address - Phone:631-235-9881
Mailing Address - Fax:888-279-5444
Practice Address - Street 1:70 GLEN ST STE 101
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2853
Practice Address - Country:US
Practice Address - Phone:631-320-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered