Provider Demographics
NPI:1336136092
Name:ROSENFELD, AVERY (RPH, CCP,CGP)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:ROSENFELD
Suffix:
Gender:M
Credentials:RPH, CCP,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17-03 ALDEN TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3587
Mailing Address - Country:US
Mailing Address - Phone:201-796-8011
Mailing Address - Fax:
Practice Address - Street 1:17-03 ALDEN TER
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3587
Practice Address - Country:US
Practice Address - Phone:201-796-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02056300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist