Provider Demographics
NPI:1184855496
Name:ROSENHOLTZ, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ROSENHOLTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PENNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4716
Mailing Address - Country:US
Mailing Address - Phone:212-989-2990
Mailing Address - Fax:212-792-6058
Practice Address - Street 1:170 PENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4716
Practice Address - Country:US
Practice Address - Phone:212-989-2990
Practice Address - Fax:212-792-6058
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health