Provider Demographics
NPI:1093863623
Name:ROSEN, LAURA EPSTEIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:EPSTEIN
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1109
Mailing Address - Country:US
Mailing Address - Phone:201-445-2929
Mailing Address - Fax:201-689-7323
Practice Address - Street 1:1 PROSPECT ST STE 6
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4421
Practice Address - Country:US
Practice Address - Phone:201-445-2929
Practice Address - Fax:201-689-7323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4163103TC0700X
NY012766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100453Medicare ID - Type UnspecifiedMEDICARE PROVIDER